Laura K Shank, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

100250 Issued in OR

Practice address

2542 NE Courtney Dr
Bend, OR 97701-7685

Phone

(541) 706-2768

Fax

(541) 706-4760

NPI assigned

Apr 5, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Laurie K Shank Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Charles Health System, Inc.

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Medicare reassignment NPD
• St. Charles Health System, Inc.

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  • Clinical Social Worker
  • Bend, OR
  • NPI 1780698696
  NPD

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1326337965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5579",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977085579",
            "telephone_number": "541-706-2768",
            "fax_number": "541-706-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2542 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017685",
            "telephone_number": "541-706-2768",
            "fax_number": "541-706-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANK",
        "first_name": "LAURA",
        "middle_name": "K",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2915-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "100250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2915-57",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lshank17435@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2542 NE Courtney Dr",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977017685",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "SHANK",
            "middle_name": "K",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Angela Shafer
• Andrew B. Shaffer
• Kelly Shaffer, MD
• Logan Shane
• Rhiannon Marie Shane
• Tyler Shanley
• Brian Shannon, MA
• Robert L Shannon, MD
• Sarah Shapiro
• Stacy Sharlet, DC

• Clinical Psychologist in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.