Individual
SHANNON KATHLEEN PUGERUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, QMHP
Contact information
Practice address
1195 NW WALL ST, BEND, OR 97703-1965
(541) 728-0062
(541) 306-6733
Mailing address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948
(541) 726-1465
(541) 726-5085
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/06/2017
Last updated
03/17/2018
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