Individual
KEVIN SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 NW BROADWAY, PORTLAND, OR 97209-3580
(503) 944-4410
Mailing address
10759 SW HERON CIR, BEAVERTON, OR 97007-8353
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23-11-30089
OR
1041C0700X
Clinical Social Worker
L17410
OR
Other
Enumeration date
07/21/2015
Last updated
12/01/2025
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