Individual
LAURIE SHEPARD-GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
0110 SW BANCROFT ST, PORTLAND, OR 97239-4062
(503) 358-4383
Mailing address
0110 SW BANCROFT ST, PORTLAND, OR 97239-4062
(503) 358-4383
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6093
OR
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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