Healthcare Provider Details

I. General information

NPI: 1215857057
Provider Name (Legal Business Name): TESSA LYNN COOPER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BROADWAY ST # 1
VANCOUVER WA
98663-3229
US

IV. Provider business mailing address

704 NW 43RD ST
VANCOUVER WA
98660-1602
US

V. Phone/Fax

Practice location:
  • Phone: 360-852-7524
  • Fax:
Mailing address:
  • Phone: 360-852-7524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC61648029
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: