Individual
VIVIAN JUNE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 966-9830
(541) 240-8754
Mailing address
PO BOX 160, PENDLETON, OR 97801-0160
(541) 966-9830
(541) 240-8754
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
20-CRM-179
OR
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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