Provider Demographics
NPI:1033522149
Name:THE CLOVER CLINIC, LLC
Entity Type:Organization
Organization Name:THE CLOVER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICIAN AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-432-5555
Mailing Address - Street 1:1530 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3237
Mailing Address - Country:US
Mailing Address - Phone:503-487-6018
Mailing Address - Fax:503-487-6127
Practice Address - Street 1:1530 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3237
Practice Address - Country:US
Practice Address - Phone:503-487-6018
Practice Address - Fax:503-487-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR1845175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty