Active NPI
Shannon Deneice Ledesma, PH.D
- Health Psychologist
- Tacoma, WA
National Provider Identifier
1578500328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 2517
- Practice address
- 9040 Jackson Ave
Tacoma, WA 98431-1894 - Phone
- (253) 968-5125
- NPI assigned
- Jun 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00002517 | WA | |
| Health Psychologist | 103TH0004X | 2517 | WA | Primary |
Addresses
Primary practice location
9040 Jackson Ave
Tacoma, WA 98431-1894
Mailing address
9040-A Jackson Ave
Tacoma, WA 98431-0001
Phone (253) 968-3517
Other practice location 1
6625 Wagner Way NW Ste 250
Gig Harbor, WA 98335-8392
Phone (253) 973-7904
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7574JO | Other | WA | REGENCE |
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 |
|---|---|---|---|
| 2517 | WA | MD | Health Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Health Management PLLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1578500328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9040-A JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-3517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984311894",
"telephone_number": "253-968-5125"
}
],
"practiceLocations": [
{
"address_1": "6625 Wagner Way NW Ste 250",
"address_purpose": "LOCATION",
"city": "Gig Harbor",
"state": "WA",
"postal_code": "983358392",
"country_code": "US",
"telephone_number": "253-973-7904",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEDESMA",
"first_name": "SHANNON",
"middle_name": "DENEICE",
"name_prefix": "Ms.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-01",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00002517",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "WA",
"license": "2517",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "7574JO",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.