Healthcare Provider Details

I. General information

NPI: 1982902425
Provider Name (Legal Business Name): STACEY GUGGINO ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 NW FLANDERS ST STE A
PORTLAND OR
97209-2646
US

IV. Provider business mailing address

2459 SE TUALATIN VALLEY HWY SUITE 416
HILLSBORO OR
97123-1247
US

V. Phone/Fax

Practice location:
  • Phone: 503-972-0235
  • Fax:
Mailing address:
  • Phone: 503-972-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC157485
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1822
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: