Shannon Grethel, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY21763 Issued in CA

Practice address

975 Sereno Dr
KFRC- Neuropsychology Department
Vallejo, CA 94589-2441

Phone

(832) 370-7960

NPI assigned

Feb 1, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Scott Hammel Partners LTD

  • Psychologist
  • Austin, TX
  • NPI 1982758827
  NPD (past)

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242950400000",
    "number": "1629256607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 SERENO DR",
            "address_2": "KFRC- NEUROPSYCHOLOGY DEPARTMENT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892441",
            "telephone_number": "707-651-4547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 SERENO DR",
            "address_2": "KFRC- NEUROPSYCHOLOGY DEPARTMENT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892441",
            "telephone_number": "832-370-7960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRETHEL",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-01",
        "last_updated": "2009-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY21763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greenfields Icf-DDN
• Greenfields Intemediate Care Facility
• Greenfields Intermediate Care Facility
• Greenfields Intermediate Care Facility
• Adam Gresham
• Amit Grewal
• Puneet Grewal
• Griffin Technology Academies (Gta)
• Laura Griffin, LCSW
• Nicole M. Griffin, MD

• Clinical Neuropsychologist in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.