Individual
NICOLE SKYE SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
625 NE GALLOWAY ST, MCMINNVILLE, OR 97128-3933
(503) 434-7523
Mailing address
629 NW CYPRESS ST, MCMINNVILLE, OR 97128-5202
(971) 716-6268
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
12/28/2018
Last updated
12/28/2018
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