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DR. SHANEEN DIANE STACER PHD NPI 1427485440


NPI Information

NPI: 1427485440
Provider Name: DR. SHANEEN DIANE STACER, PHD
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
1900 WOODLAND DR
COOS BAY, OR
ZIP 97420
Phone: (541) 267-5151
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DR. Shaneen Diane Stacer, PHD is a clinical psychologist in Coos Bay, OR. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR. Shaneen Diane Stacer, PHD NPI is 1427485440. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1900 WOODLAND DR
COOS BAY, OR
ZIP 97420-045
Phone: (541) 267-5151
Fax: (541) 266-4554

The NPI 1427485440 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 10/4/2013 and was last updated on 9/8/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103T00000XPsychologist3079-57WISCONSINNo
2103TA0400XPsychologistAddiction (Substance Use Disorder)3079-57WISCONSINNo
3103TB0200XPsychologistCognitive & Behavioral3079-57WISCONSINNo
4103TC0700XPsychologistClinical3079-57WISCONSINNo
5103TC2200XPsychologistClinical Child & Adolescent3079-57WISCONSINNo
6103TH0004XPsychologistHealth3079-57WISCONSINNo
7103TH0100XPsychologistHealth Service3079-57WISCONSINNo
8103TP2701XPsychologistGroup Psychotherapy3079-57WISCONSINNo
9103TC0700XPsychologistClinical2500OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1161133OTHEROREGONNORTH BEND MEDICAL CENTER GROUP MEDICAID
2500684206MEDICAIDOREGON
31407812365OTHEROREGONNORTH BEND MEDICAL CENTER GROUP NPI
4R180416MEDICARE PINOREGON
5R0000WFBTVOTHEROREGONNORTH BEND MEDICAL CENTER GROUP MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.