Provider Demographics
NPI:1932770468
Name:SHELTON, MICHELLE E (EDD, MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:SHELTON
Suffix:
Gender:F
Credentials:EDD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 N ROGER SMITH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2459
Mailing Address - Country:US
Mailing Address - Phone:503-200-7671
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR STE 113
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2432
Practice Address - Country:US
Practice Address - Phone:503-200-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health