Healthcare Provider Details

I. General information

NPI: 1033522149
Provider Name (Legal Business Name): THE CLOVER CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E 1ST ST
NEWBERG OR
97132-3237
US

IV. Provider business mailing address

1530 E 1ST ST
NEWBERG OR
97132-3237
US

V. Phone/Fax

Practice location:
  • Phone: 503-487-6018
  • Fax: 503-487-6127
Mailing address:
  • Phone: 503-487-6018
  • Fax: 503-487-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberOR1845
License Number StateOR

VIII. Authorized Official

Name: DR. LEAH MICHELLE OLSEN
Title or Position: LEAD PHYSICIAN AND OWNER
Credential: ND
Phone: 503-432-5555