Provider Demographics
NPI:1043564628
Name:ANNALA, KATHERINE ELLEN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELLEN
Last Name:ANNALA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SE 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3014
Mailing Address - Country:US
Mailing Address - Phone:503-544-4336
Mailing Address - Fax:
Practice Address - Street 1:10541 SE CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2826
Practice Address - Country:US
Practice Address - Phone:503-445-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC160265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist