Healthcare Provider Details

I. General information

NPI: 1205745551
Provider Name (Legal Business Name): ANNA MAHONEY L.AC, DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 NE 6TH AVE
PORTLAND OR
97211-3041
US

IV. Provider business mailing address

6345 NE 6TH AVE
PORTLAND OR
97211-3041
US

V. Phone/Fax

Practice location:
  • Phone: 508-498-8727
  • Fax:
Mailing address:
  • Phone: 508-498-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC231491
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: