Shannon Modjeski

NPI 1265786396 · on the registry since 2012

Practice

Address: 816 W 10th St
Medford, OR 97501
Phone: (541) 734-5437
Fax: (541) 734-2425
Organisation at this address: Jackson Co Child Abuse Task Force Inc
Jackson County Child Abuse Task Force Inc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 7

Registry record

Primary taxonomy: 101Y00000X
101Y00000X
Licence states on file: AZ
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2016-06-01

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon