Individual
SHANNON MARIE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2440 WILLAMETTE ST STE 201, EUGENE, OR 97405-3170
(541) 321-2278
Mailing address
223 COMMERCIAL ST NE STE 205, SALEM, OR 97301-4078
(503) 966-2722
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C6686
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500775892
—
OR
Enumeration date
01/08/2020
Last updated
01/25/2024
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