Provider Demographics
NPI:1053191999
Name:OCONNOR-WOLF, SHANA (MFTA)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:
Last Name:OCONNOR-WOLF
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19426 75TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-7916
Mailing Address - Country:US
Mailing Address - Phone:425-770-9881
Mailing Address - Fax:
Practice Address - Street 1:2320 130TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1752
Practice Address - Country:US
Practice Address - Phone:425-646-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61461214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist