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General NPI Number Information
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NPI Number | 1922996933
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Entity Type | Organization
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Legal Business Name | CLOVER CLINIC COMMUNITY SERVICES
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 114 E 2ND ST
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City | NEWBERG
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State | OR
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Zip | 97132-3001
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Country | US
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Telephone | 503-487-6018
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Fax | 888-732-4191
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Provider Business Mailing Address
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Address Line | 114 E 2ND ST
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City | NEWBERG
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State | OR
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Zip | 97132-3001
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Country | US
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Telephone | 503-487-6018
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Fax | 888-732-4191
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LEAH ULSTED
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Credential | ND
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Telephone | 503-487-6018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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