Individual
SHAY FOREST WITTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
2222 NW LOVEJOY ST STE 606, PORTLAND, OR 97210-5104
(503) 413-5915
Mailing address
8803 N TYNDALL AVE, PORTLAND, OR 97217-7029
(541) 805-9282
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E10249501
OR
Other
Enumeration date
10/30/2024
Last updated
12/15/2024
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