Healthcare Provider Details

I. General information

NPI: 1063175438
Provider Name (Legal Business Name): CARYN SHEBOWICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 SW 13TH AVE
PORTLAND OR
97205-1703
US

IV. Provider business mailing address

PO BOX 3007
PORTLAND OR
97208-3007
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-3860
  • Fax:
Mailing address:
  • Phone: 503-535-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: