Individual
SHANNON R KERTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3102 NE DEKUM ST, PORTLAND, OR 97211-6638
(503) 777-7777
Mailing address
3102 NE DEKUM ST, PORTLAND, OR 97211-6638
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15680
OR
Other
Enumeration date
07/18/2011
Last updated
05/27/2015
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