Healthcare Provider Details

I. General information

NPI: 1699670612
Provider Name (Legal Business Name): CONNER MCCLURE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6443 SW BEAVERTON HILLSDALE HWY
PORTLAND OR
97221-1164
US

IV. Provider business mailing address

3944 SW BEAVERTON HILLSDALE HWY
PORTLAND OR
97221-3650
US

V. Phone/Fax

Practice location:
  • Phone: 503-452-8002
  • Fax:
Mailing address:
  • Phone: 971-222-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: