Healthcare Provider Details

I. General information

NPI: 1831533975
Provider Name (Legal Business Name): JONATHAN SHAFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 SW WESTGATE DR STE 320
PORTLAND OR
97221-2447
US

IV. Provider business mailing address

7414 SE 70TH AVE
PORTLAND OR
97206-7930
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-9211
  • Fax:
Mailing address:
  • Phone: 614-256-5172
  • Fax: 775-331-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number5005
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: