Individual
EVELYN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
118 N KILLINGSWORTH ST, PORTLAND, OR 97217-2435
(503) 288-4454
Mailing address
3424 NE JESSUP ST, PORTLAND, OR 97211-7424
(503) 739-5913
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023525
OR
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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