Provider Demographics
NPI:1700296266
Name:SEVERN, SHANNA (NCC)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:SEVERN
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30150 SW PARKWAY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6836
Mailing Address - Country:US
Mailing Address - Phone:971-264-4505
Mailing Address - Fax:
Practice Address - Street 1:8855 SW HOLLY LN
Practice Address - Street 2:SUITE 126
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8854
Practice Address - Country:US
Practice Address - Phone:971-264-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health