Shawna Ruth Gillespie

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1 Serenity LN
Coburg, OR 97408-9350

Phone

(541) 284-5724

NPI assigned

Mar 15, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shawna Ruth Tyson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1285137299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SERENITY LN",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974089350",
            "telephone_number": "541-284-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SERENITY LN",
            "city": "COBURG",
            "state": "OR",
            "postal_code": "974089350",
            "telephone_number": "541-284-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLESPIE",
        "first_name": "SHAWNA",
        "middle_name": "RUTH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-15",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAWNA",
            "last_name": "TYSON",
            "middle_name": "RUTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Karine Garabedian, PSS, CRM, CADC-R
• Delilah Garza
• Tashina Rae Gibbins, CADC-R
• Emily Elise Gibson, CADC I
• Cheryl Anne Gifford, PH.D.
• Douglas Gomez, PHD
• Claire Gosslee
• Alissa Hallock
• Noor Hamdy
• Christopher James Harrington, MA, QMHP, CADC3, MAC

• All providers in Coburg, OR
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.