Provider Demographics
NPI:1740679935
Name:RENFRO SMITH, SHENANDOAH LOUISE (LCSW, CADC1)
Entity type:Individual
Prefix:
First Name:SHENANDOAH
Middle Name:LOUISE
Last Name:RENFRO SMITH
Suffix:
Gender:F
Credentials:LCSW, CADC1
Other - Prefix:
Other - First Name:SHENANDOAH
Other - Middle Name:LOUISE
Other - Last Name:RENFRO-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8915 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6307
Mailing Address - Country:US
Mailing Address - Phone:503-374-2681
Mailing Address - Fax:
Practice Address - Street 1:2051 KAEN RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:971-269-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL112561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical