Individual
MS. SHANNON M BARNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
12445 SE WHITCOMB DR, APT # 1, MILWAUKIE, OR 97222-6992
(503) 962-9016
Mailing address
10001 SE SUNNYSIDE RD, SUITE 204, CLACKAMAS, OR 97015-5746
(503) 962-9016
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
LICENSE MASSAGE THERAPIST
OR
Enumeration date
11/18/2011
Last updated
11/18/2011
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