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Individual

SHELLY RAE FOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9615 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Mailing address
9615 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000108778
OR

Other

Enumeration date
04/19/2023
Last updated
04/19/2023
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