Individual
MR. ROBERT SHANE RICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC I, CRM
Contact information
Practice address
3793 RIVER RD N, KEIZER, OR 97303-4827
(503) 304-7002
(503) 304-7049
Mailing address
3793 RIVER RD N STE A, KEIZER, OR 97303-4827
(503) 304-7002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12-12-53
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500608214
—
OR
Enumeration date
01/30/2013
Last updated
05/01/2013
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