Individual
JO ANNE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-II
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-3450
Mailing address
3125 QUAIL AVE SE, ALBANY, OR 97322-8910
(541) 704-0700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
A3735496
CA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
10-R-06
OR
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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