Provider Demographics
NPI:1366230286
Name:WYLAND, SHANNON ARLENE (QMHA-R)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ARLENE
Last Name:WYLAND
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2113
Mailing Address - Country:US
Mailing Address - Phone:541-388-8459
Mailing Address - Fax:541-388-8116
Practice Address - Street 1:215 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2113
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:541-388-8116
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator