Provider Demographics
NPI:1790402667
Name:BJERKE, SHANON L
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:L
Last Name:BJERKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89-1046 OLD MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704
Mailing Address - Country:US
Mailing Address - Phone:406-788-0938
Mailing Address - Fax:
Practice Address - Street 1:89-1046 OLD MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:99704-9970
Practice Address - Country:US
Practice Address - Phone:406-788-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst