SHANNON NICHOLE MODJESKI
NPI 1265786396
Counselor in Medford, OR

Q: What is Shannon Modjeski's NPI number?

The NPI number for Shannon Modjeski is 1265786396. It was assigned to this individual provider in the NPPES registry on October 26, 2012. The provider is also known as Shannon Nichole Marcus.

Q: What is Shannon Modjeski's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: Is Shannon Modjeski enrolled in Medicare?

No. Shannon Modjeski has opted out of Medicare through January 22, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Shannon Modjeski was last updated on June 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 26, 2012Opted out of Medicare · through Jan 22, 2028

816 W 10TH ST, MEDFORD, OR 97501(541) 734-5437(541) 734-2425 Get Directions Write a Review

NPPES record last updated: June 1, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Shannon Nichole Modjeski NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON NICHOLE MODJESKI (NPI 1265786396) is an individual counselor in Medford, Oregon, licensed in Arizona (LAC14009) and active in the NPI registry since October 2012. She has opted out of Medicare through January 22, 2028.

NPPES Registry Identity

NPI1265786396

Entity TypeIndividualFemale

Primary Taxonomy101Y00000X

Provider Legal NameSHANNON NICHOLE MODJESKI

Location Address816 W 10TH STMedford, OR 97501-3016

Mailing Address816 W 10th StMedford, OR 97501-3016 · (541) 734-5437 · Fax (541) 734-2425

Phone(541) 734-5437

Fax(541) 734-2425

Sole ProprietorNo

Enumeration DateOctober 26, 2012

Last NPPES UpdateJune 1, 2016

✔ NPI 1265786396 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

License✔ Licensed in AZ · LAC14009

Definition

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.

816 W 10TH ST, Medford, OR 97501

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Other Names 1

Former Name (1)Shannon Nichole Marcus

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Shannon Nichole Modjeski has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 22, 2026 through January 22, 2028.

Opt-Out Effective DateJanuary 22, 2026

Opt-Out In Effect ThroughJanuary 22, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHIREEN NICOLE CHAMBERLAND MD

Family Medicine