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NPI Code Detail

MEDICARE: CAROL PATRICIA CONGDON LAC

MEDICARE: CAROL PATRICIA CONGDON 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
1225700000XMassage Therapist7381OR
2171100000XAcupuncturist154157OR

General Provider Information

NPI Number : 1598948978
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL PATRICIA CONGDON LAC
Provider Business Mailing Address
First Line : 4425 SW CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4260
Country : US
Telephone Number : 503-317-6347
Fax Number :
Provider Business Practice Location Address
First Line : 4425 SW CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4260
Country : US
Telephone Number : 503-317-6347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2007
Last Update Date : 04/30/2018

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Directions to “ CAROL PATRICIA CONGDON LAC” Practice Location

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