Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1740 | OR |
NPI | 1003181983 |
---|---|
Provider Name | Jeni Lynne Shilman |
First Address | Portland, OR 97210-5311 |
Second Address | Portland, OR 97210-5311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2012 |
Last Update Date | 12/03/2012 |