Individual
SHANNON K FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4275 SW 148TH AVE, BEAVERTON, OR 97078-2773
(503) 520-4700
Mailing address
11782 SW BARNES RD, PORTLAND, OR 97225-5914
(650) 387-1712
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2025
Last updated
10/31/2025
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