Individual
DIETRICH J SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 W 2ND ST, #U, YAMHILL, OR 97148-2204
(503) 560-8881
Mailing address
PO BOX 284, YAMHILL, OR 97148-0284
(503) 560-8881
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/08/2013
Last updated
06/08/2013
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