Provider Demographics
NPI:1821841107
Name:HAYTER, SHANNON LYNN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:HAYTER
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 1:2788 NW RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2457
Mailing Address - Country:US
Mailing Address - Phone:971-230-8668
Mailing Address - Fax:
Practice Address - Street 1:2788 NW RALEIGH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2457
Practice Address - Country:US
Practice Address - Phone:971-230-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor