Healthcare Provider Details

I. General information

NPI: 1316163108
Provider Name (Legal Business Name): SHARLENE JUNE CAMPBELL L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15220 NW GREENBRIER PKWY STE 260
BEAVERTON OR
97006-8111
US

IV. Provider business mailing address

9443 NW KAISER RD
PORTLAND OR
97231-2734
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9494
  • Fax:
Mailing address:
  • Phone: 971-717-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7568
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: