Provider Demographics
NPI:1942644034
Name:GILLIGAN, SHANNON MARIE (BS LIFE SCIENCE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:BS LIFE SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3007
Mailing Address - Country:US
Mailing Address - Phone:503-535-1151
Mailing Address - Fax:503-535-1190
Practice Address - Street 1:205 SE 3RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4093
Practice Address - Country:US
Practice Address - Phone:503-535-1181
Practice Address - Fax:503-693-6474
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health