Individual
JONATHAN TAYLOR SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
847 NE 19TH AVE, PORTLAND, OR 97232-2684
(971) 282-5901
Mailing address
5402 NE HOYT ST, PORTLAND, OR 97213-3067
(971) 282-5901
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
101Y00000X
OR
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
06/01/2011
Last updated
02/23/2015
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