MEDICARE: JENNIFER M WARD LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC170268	OR

General Provider Information

NPI Number	:	1356730956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M WARD LAC

Provider Business Mailing Address
First Line	:	3970 N INTERSTATE AVE
Second Line	:	UNIT 309
City	:	PORTLAND
State	:	OR
Zip	:	97227-1082
Country	:	US
Telephone Number	:	917-701-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	4847 MEADOWS RD
Second Line	:	SUITE 153
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-2509
Country	:	US
Telephone Number	:	503-719-5335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	01/20/2015

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