Active NPI
Shirley K Shen, PHD
- Clinical Psychologist
- Vancouver, WA
National Provider Identifier
1306921846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00002736
- Practice address
- 1701 E Evergreen Blvd
Vancouver, WA 98661-4289 - Phone
- (503) 998-6238
- Fax
- (360) 326-1651
- NPI assigned
- Oct 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00002736 | WA | Primary |
Addresses
Primary practice location
1701 E Evergreen Blvd
Vancouver, WA 98661-4289
Mailing address
703 NW 151St St
Vancouver, WA 98685-1753
Phone (503) 998-6238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164936 | Other | OR | PERSONAL MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00002736 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1306921846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 NW 151ST ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986851753",
"telephone_number": "503-998-6238",
"fax_number": "360-326-1651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 E EVERGREEN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986614289",
"telephone_number": "503-998-6238",
"fax_number": "360-326-1651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEN",
"first_name": "SHIRLEY",
"middle_name": "K",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-25",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00002736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL MEDICARE",
"identifier": "164936",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.