Provider Demographics
NPI:1407250772
Name:YATES, SHAWNTE (ND, LAC)
Entity Type:Individual
Prefix:
First Name:SHAWNTE
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SE ALDER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2400
Mailing Address - Country:US
Mailing Address - Phone:360-448-3969
Mailing Address - Fax:503-954-2374
Practice Address - Street 1:1110 SE ALDER ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:360-448-3969
Practice Address - Fax:503-954-2374
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC169326171100000X
OR2073175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist