Individual ProviderShannon DaughertySocial WorkerBehavioral Health & Social Service ProvidersPractice Address1904 SE Division St, Portland, OR 97202-1146(503) 517-8663PECOS EnrollmentBased on the most recent information from CMS, provider Shannon Daugherty 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 ID1396287207Provider TypeIndividualFull NameDaugherty, ShannonCredentialMSWGenderFemaleSole ProprietorNoEnumeration Date11/8/2016Last Updated11/8/2016Contact InformationPractice LocationPractice Address1904 SE Division St, Portland, OR 97202-1146Phone(503) 517-8663FaxUnlisted FaxMailing LocationMailing Address1904 SE Division St, Portland, OR 97202-1146Phone(503) 517-8663FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer