Individual
DR. SHELLY CLEVIDENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.D.
Contact information
Practice address
3021 SE DIVISION ST, PORTLAND, OR 97202-1476
(503) 319-1901
Mailing address
4722 SE TOLMAN ST, PORTLAND, OR 97206-6932
(503) 319-1901
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
1516
OR
Other
Enumeration date
10/19/2007
Last updated
10/19/2007
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