MEDICARE: LAREAUX BEAUTY & WELLNESS

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1952007478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAREAUX BEAUTY & WELLNESS

Provider Business Mailing Address
First Line	:	4701 NE KILLINGSWORTH ST APT A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1989
Country	:	US
Telephone Number	:	971-380-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 LLOYD CTR
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1315
Country	:	US
Telephone Number	:	971-380-8995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHEQOUYA JOHNSON
Credential	:
Telephone Number	:	971-380-8995

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/16/2024

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Directions to “LAREAUX BEAUTY & WELLNESS ” Practice Location

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