Provider Demographics
NPI:1083942437
Name:LEBAS, MEGAN JANE (LAC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:LEBAS
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 1:811 NW 20TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1443
Mailing Address - Country:US
Mailing Address - Phone:971-235-0813
Mailing Address - Fax:
Practice Address - Street 1:811 NW 20TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1443
Practice Address - Country:US
Practice Address - Phone:971-235-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist