Healthcare Provider Details

I. General information

NPI: 1922996933
Provider Name (Legal Business Name): CLOVER CLINIC COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 2ND ST
NEWBERG OR
97132-3001
US

IV. Provider business mailing address

114 E 2ND ST
NEWBERG OR
97132-3001
US

V. Phone/Fax

Practice location:
  • Phone: 503-487-6018
  • Fax: 888-732-4191
Mailing address:
  • Phone: 503-487-6018
  • Fax: 888-732-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: LEAH ULSTED
Title or Position: PHYSICIAN
Credential: ND
Phone: 503-487-6018