Provider Demographics
NPI:1770018285
Name:KRECKLOW, SHAYLA (LPCC)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:KRECKLOW
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 SE FOSTER RD., SUITE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4686
Mailing Address - Country:US
Mailing Address - Phone:503-882-0884
Mailing Address - Fax:503-882-0887
Practice Address - Street 1:6510 SE FOSTER RD., SUITE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4686
Practice Address - Country:US
Practice Address - Phone:503-882-0884
Practice Address - Fax:503-882-0887
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800882101YM0800X
ORC9888101YM0800X
OHC1500660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health