Individual
MR. SHANE PATRICK LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
KAISER SUNNYSIDE MEDICAL OFFICE, 10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9764
(503) 571-1995
Mailing address
10180 SE SUNNYSIDE ROAD, CLACKAMAS, OR 97015-9303
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3249
OR
Other
Enumeration date
08/23/2006
Last updated
03/06/2022
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