Individual
MS. LEAH SHIRLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7070 SE 16TH AVE, PORTLAND, OR 97202-5709
(503) 232-9642
Mailing address
7070 SE 16TH AVE, PORTLAND, OR 97202-5709
(503) 232-9642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17701
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17701
LMT
OR
Enumeration date
07/07/2015
Last updated
07/07/2015
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