Provider Demographics
NPI:1821709387
Name:HOXSIE, SHANNAN KYLIE (CSWA)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:KYLIE
Last Name:HOXSIE
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2522
Mailing Address - Country:US
Mailing Address - Phone:503-362-2481
Mailing Address - Fax:503-371-7803
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2522
Practice Address - Country:US
Practice Address - Phone:503-362-2481
Practice Address - Fax:503-371-7803
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA13822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker