Individual
SHADD CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 880-2011
Mailing address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170061
—
OR
Enumeration date
02/28/2017
Last updated
02/28/2017
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