SHANNON DWAYNE KRETZ (NPI# 1861977936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861977936 |
| Entity Type | Individual |
| Full Name | SHANNON DWAYNE KRETZ |
| Other Name | SHANNON DWAYNE BENJAMIN |
| Credential | AA, CDPT |
| Practice Address |
309 Oak St Kelso WA 98626-2340 |
| Mailing Address |
921 14th Avenue Longview WA 98632 |
| Practice Telephone | 3604230203 |
| Practice Fax Number | 3605777904 |
| Mailing Telephone | 3604230203 |
| Mailing Fax Number | 3605770269 |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2019-02-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 60871961 | WA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2108137 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710225867 | Shannon Dawn Kretz | Licensed Practical Nurse | 164 Waccamaw Medical Park Dr, Conway, SC 29526-8903 | 2013-01-24 |
| Street Address |
309 OAK ST |
| City | KELSO |
| State | WA |
| Zip Code | 98626-2340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134373574 | C & R Executives, LLC | Clinic/Center | 309 Oak St, Kelso, WA 98626-2340 | 2008-11-12 |
| 1982140893 | Mary Kathleen Sullivan | Counselor | 309 Oak St, Kelso, WA 98626-2340 | 2017-01-16 |
| 1780054197 | Paul Allen Welk | Counselor | 309 Oak St, Kelso, WA 98626-2340 | 2015-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730581877 | Wrothell Funchess | Counselor | 1645 Bowmont Ave, Kelso, WA 98626 | 2014-09-19 |
| 1427457688 | Julie Dalen | Counselor | 309 Oak Street, Kelso, WA 98626 | 2014-08-13 |
| 1033468822 | Rene Kerry Bohannon-oxford | Counselor | 2707 Pacific Ave North, Kelso, WA 98626 | 2012-09-07 |
| 1447535737 | Nichole Kathleen Allee | Massage Therapist | 109 Nw 1st St., Kelso, WA 98626 | 2011-10-18 |
| 1689991655 | Zachariah Kramer | Radiology | 700 Lincoln Street Suite 100, Longview Radiologists, Kelso, WA 98626 | 2010-04-29 |
| 1508007071 | Robert Lee Blair | Registered Nurse | 119 Blackburn Lane, Kalama, WA 98626 | 2009-03-13 |
| 1942318829 | Imholte & Anderson Pllc | Dentist | 409 West Main Street, Kelso, WA 98626 | 2006-08-29 |
| 1922088723 | James Bevan Hollingsworth | Pharmacist | 204 S Pacific Ave, Kelso, WA 98626 | 2006-01-18 |
| 1972021087 | Adreia Jenice Jessop | Registered Nurse | 300 Oak St, Kelso, WA 98626 | 2017-09-08 |
| 1023567310 | Charlene Han | Pharmacist | 205 Three Rivers Dr, Kelso, WA 98626 | 2016-09-27 |
| Find all providers in zip 98626 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194200279 | Grace Hoinowski | Counselor | 305 Pacific Ave S, Kelso, WA 98626-1638 | 2018-09-25 |
| 1902225501 | Keisha Lee | Counselor | 206 Nw 2nd Ave, Kelso, WA 98626-1323 | 2014-04-10 |
| 1033468822 | Rene Kerry Bohannon-oxford | Counselor | 2707 Pacific Ave North, Kelso, WA 98626 | 2012-09-07 |
| 1265789879 | Dee J.f. Witt | Counselor | 1710 Allen St, Kelso, WA 98626-4907 | 2012-08-14 |
| 1679874770 | Olivia E Lovely | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2010-11-06 |
| 1003464355 | Ariel Jones | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2019-08-29 |
| 1447717632 | Scott C Miller | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2019-02-25 |
| 1457841215 | Matthew Lewis Spurlock | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2018-05-16 |
| 1700394426 | Dusty Ralynn Carter | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2018-01-16 |
| 1134631021 | Maria L Mix | Counselor | 305 Pacific Ave S Ste 102, Kelso, WA 98626-1638 | 2017-10-31 |
| Find all providers in KELSO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.