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General NPI Number Information
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NPI Number | 1639508831
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Entity Type | Individual
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Provider Name | JULIA MORTLOCK ND, LAC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 09/26/2015
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Provider Practice Location Address
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Address Line | 16904 SE 1ST ST
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City | VANCOUVER
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State | WA
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Zip | 98684-8511
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Country | US
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Telephone | 541-979-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 7121 SW 29TH AVE
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City | PORTLAND
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State | OR
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Zip | 97219-1907
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Country | US
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Telephone | 541-979-6467
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60416884
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC164766
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NT60416820
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 2012
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License Number State | OR
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