Healthcare Provider Details

I. General information

NPI: 1649435009
Provider Name (Legal Business Name): NIKKIE RENEE MOSKALIK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKIE RENEE LATTION LMT

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 GLEN OAK DR
EUGENE OR
97405-4734
US

IV. Provider business mailing address

3555 GLEN OAK DR
EUGENE OR
97405-4734
US

V. Phone/Fax

Practice location:
  • Phone: 541-579-5587
  • Fax:
Mailing address:
  • Phone: 541-579-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14233
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: