Provider Demographics
NPI:1184926792
Name:MAEPA HORN, SHAWN L (LBA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:MAEPA HORN
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15685 SW 116TH AVE
Mailing Address - Street 2:PMB #240
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2120 SW JEFFERSON ST
Practice Address - Street 2:SUITE B200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-7727
Practice Address - Country:US
Practice Address - Phone:503-244-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10167930103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst