Provider Demographics
NPI:1184095606
Name:ARENAS, SHANNON NICOLE (BA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:ARENAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:12240 SW DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4529
Mailing Address - Country:US
Mailing Address - Phone:714-398-3652
Mailing Address - Fax:
Practice Address - Street 1:4724 SW MACADAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-235-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst