Individual
SHY'ANN CHRISTINE LEA MORDECAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3180 CENTER ST NE, SALEM, OR 97301-4532
(503) 585-4949
Mailing address
3180 CENTER ST NE, SALEM, OR 97301-4532
(503) 585-4949
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122994
—
OR
Enumeration date
01/17/2025
Last updated
01/17/2025
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