Healthcare Provider Details

I. General information

NPI: 1164017604
Provider Name (Legal Business Name): MS. SHIRIN YEKEKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NE STUCKI AVE STE 308
HILLSBORO OR
97006-6951
US

IV. Provider business mailing address

1915 NE STUCKI AVE STE 308
HILLSBORO OR
97006-6951
US

V. Phone/Fax

Practice location:
  • Phone: 971-270-0116
  • Fax:
Mailing address:
  • Phone: 971-270-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA12337
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11765
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: