Provider Demographics
NPI:1174865422
Name:COFFIN, KILEEN JOY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KILEEN
Middle Name:JOY
Last Name:COFFIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KILEEN
Other - Middle Name:JOY
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1029 N STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:503-351-5466
Mailing Address - Fax:
Practice Address - Street 1:1633 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-465-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR160234171100000X
ORAC160234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist