Provider Demographics
NPI:1235414822
Name:MCCUBBINS, ALICIA ANN (ND)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:MCCUBBINS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4257
Mailing Address - Country:US
Mailing Address - Phone:503-658-7715
Mailing Address - Fax:503-658-7181
Practice Address - Street 1:3200 SE 164TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1110
Practice Address - Country:US
Practice Address - Phone:360-406-4884
Practice Address - Fax:360-406-4881
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4373175F00000X
WA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath