Individual
CORIE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 255-4205
Mailing address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 255-4205
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
01/09/2011
Last updated
01/31/2011
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