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General NPI Number Information
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NPI Number | 1396177895
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Entity Type | Individual
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Provider Name | SERENITY CELESTIA ACKLEY LMT
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Gender | Female
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 15110 BOONES FERRY RD SUITE 100C
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3468
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Country | US
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Telephone | 503-422-9497
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SW EDGEWAY DR APT J 186
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City | BEAVERTON
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State | OR
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Zip | 97006-3978
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Country | US
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Telephone | 503-422-9497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19933
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License Number State | OR
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