Healthcare Provider Details

I. General information

NPI: 1568326304
Provider Name (Legal Business Name): AMANDA ST. CLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 N MISSISSIPPI AVE
PORTLAND OR
97227-1163
US

IV. Provider business mailing address

3355 NE 75TH AVE
PORTLAND OR
97213-5860
US

V. Phone/Fax

Practice location:
  • Phone: 503-517-8222
  • Fax:
Mailing address:
  • Phone: 503-970-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29237
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: