Individual ProviderShannon BoulterSocial WorkerBehavioral Health & Social Service ProvidersPractice Address9300 NE Oak View Dr, Vancouver, WA 98662-6192(360) 567-2211PECOS EnrollmentBased on the most recent information from CMS, provider Shannon Boulter does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1295197267Provider TypeIndividualFull NameBoulter, ShannonCredentialB.A.GenderFemaleSole ProprietorYesEnumeration Date3/28/2016Last Updated3/28/2016Contact InformationPractice LocationPractice Address9300 NE Oak View Dr, Vancouver, WA 98662-6192Phone(360) 567-2211Fax(360) 567-2212Mailing LocationMailing Address9300 NE Oak View Dr Ste B, Vancouver, WA 98662-6157Phone(360) 567-2211Fax(360) 567-2212Provider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseCG60580695Washington