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General NPI Number Information
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NPI Number | 1730977836
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Entity Type | Individual
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Provider Name | ELISABETH BALLANTINE WALDEN LMT
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2305 SE WASHINGTON ST
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City | MILWAUKIE
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State | OR
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Zip | 97222-7647
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Country | US
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Telephone | 213-300-8927
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Fax |
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Provider Business Mailing Address
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Address Line | 12992 SE RUSK RD
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City | MILWAUKIE
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State | OR
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Zip | 97222-2106
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Country | US
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Telephone | 914-471-0679
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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 | 28964
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License Number State | OR
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