Healthcare Provider Details

I. General information

NPI: 1053569764
Provider Name (Legal Business Name): SHELLEY SOBEL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 NW EVERGREEN PKWY
HILLSBORO OR
97124-7031
US

IV. Provider business mailing address

19400 NW EVERGREEN PKWY
HILLSBORO OR
97124-7031
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-5038
  • Fax: 503-690-5025
Mailing address:
  • Phone: 503-690-5038
  • Fax: 503-690-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: