Individual
SAMANTHA MARIE SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
215 SE JACKSON STREET, ROSEBURG, OR 97470
(541) 464-6401
Mailing address
215 SE JACKSON STREET, ROSEBURG, OR 97470
(541) 464-6401
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366697690
—
OR
Enumeration date
11/06/2014
Last updated
11/06/2014
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