Healthcare Provider Details

I. General information

NPI: 1235463167
Provider Name (Legal Business Name): CHRIS W CLAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 SW WASHINGTON ST
PORTLAND OR
97205-2327
US

IV. Provider business mailing address

189 SW 3RD AVE
CANBY OR
97013-4141
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-1185
  • Fax: 503-535-1192
Mailing address:
  • Phone: 503-263-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: