Most Relevant Information
Provider Data
| NPI Number: | 1003586819 |
| Provider Name: | SHELBY MCKENZIE SPADE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/14/2021 |
| Last Updated: | 09/14/2021 |
Provider Practice Location
22018 S CENTRAL POINT RD
CANBY
OR
970138705
Practice Location Phone/Fax
| Phone: | 5032214531 |
| Fax: |
Provider Mailing Location
4305 SE 59TH AVE
PORTLAND
OR
972063853
Provider Mailing Phone/Fax
| Phone: | 5855450708 |
| Fax: |