Healthcare Provider Details

I. General information

NPI: 1548180904
Provider Name (Legal Business Name): LUCJA HANCOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 STATE ST
SALEM OR
97301-3866
US

IV. Provider business mailing address

3406 SE 118TH AVE
PORTLAND OR
97266-1612
US

V. Phone/Fax

Practice location:
  • Phone: 503-908-6050
  • Fax:
Mailing address:
  • Phone: 385-770-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: