Basic Information
| Provider Information | |||||||||
| NPI: | 1306024955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUMAKER | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8915 SW CENTER ST | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037263796 | ||||||||
| FaxNumber: | 5036442616 | ||||||||
| Practice Location | |||||||||
| Address1: | 8915 SW CENTER ST | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037263698 | ||||||||
| FaxNumber: | 5037263699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW11569 | AZ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 346214 | 05 | AZ | MEDICAID |