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Individual

JENNIFER K SHOCKLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, RN, PMHNP-BC

Contact information

Practice address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
(503) 707-1053
(541) 512-6127
Mailing address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
(503) 707-1053
(541) 512-6127

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN199413
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10031539
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
313153
AZ

Other

Enumeration date
03/24/2009
Last updated
06/02/2026
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