Healthcare Provider Details

I. General information

NPI: 1285200899
Provider Name (Legal Business Name): ALECIA RACHEL YOUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date: 04/03/2023
Reactivation Date: 05/01/2026

III. Provider practice location address

3181 SW SAM JACKSON PARK ROAD
PORTLAND OR
97239
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK ROAD
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8211
  • Fax:
Mailing address:
  • Phone: 716-829-3999
  • Fax: 716-829-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: