Provider Demographics
NPI:1235377961
Name:MATTHEWS, LINDSAY ELLEN (MACOM, LAC)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ELLEN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MACOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 SE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5302
Mailing Address - Country:US
Mailing Address - Phone:503-313-2871
Mailing Address - Fax:
Practice Address - Street 1:375 N STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3111
Practice Address - Country:US
Practice Address - Phone:503-908-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist