Healthcare Provider Details

I. General information

NPI: 1033957295
Provider Name (Legal Business Name): LICE CHARMERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 SW CANYON RD STE 230
BEAVERTON OR
97005-1961
US

IV. Provider business mailing address

10445 SW CANYON RD STE 230
BEAVERTON OR
97005-1961
US

V. Phone/Fax

Practice location:
  • Phone: 503-505-6695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: JAMES DUGGAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 503-505-6695