Provider Demographics
NPI:1114048980
Name:SJAASTAD, MARILYN (LAC,MA,MS)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:SJAASTAD
Suffix:
Gender:F
Credentials:LAC,MA,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3573
Mailing Address - Country:US
Mailing Address - Phone:541-344-8088
Mailing Address - Fax:541-343-2663
Practice Address - Street 1:1210 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3573
Practice Address - Country:US
Practice Address - Phone:541-344-8088
Practice Address - Fax:541-343-2663
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist