Provider Demographics
NPI:1902245145
Name:SHAWVER, MICHELLE LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LOUISE
Last Name:SHAWVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NW PARK PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2954
Mailing Address - Country:US
Mailing Address - Phone:541-508-7746
Mailing Address - Fax:
Practice Address - Street 1:45 NW PARK PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2954
Practice Address - Country:US
Practice Address - Phone:541-508-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2158103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist