Individual
SHANE ROBERT EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S./ QMHA
Contact information
Practice address
1500 N.E. IRVING ST., SUITE 250, PORTLAND, OR 97232
(503) 233-4356
Mailing address
816 MADISON ST. A, OREGON CITY, OR 97045-1929
(503) 256-3040
(503) 256-9601
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/16/2007
Last updated
11/16/2007
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