Individual
LAURA K SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2542 NE COURTNEY DR, BEND, OR 97701-7685
(541) 706-2768
(541) 706-4760
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-2768
(541) 706-4760
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
100250
OR
103TC0700X
Clinical Psychologist
2915-57
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2915-57
LICENSE
WI
Enumeration date
04/05/2011
Last updated
04/21/2020
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