Individual
RUSS SHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
760 NW HARRIMAN ST, BEND, OR 97703-2789
(231) 631-5952
Mailing address
760 NW HARRIMAN ST, BEND, OR 97703-2789
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A16842
OR
Other
Enumeration date
11/07/2022
Last updated
08/19/2025
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