Provider Demographics
NPI:1326193566
Name:FERGUSON, KARIN GOODELL (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:GOODELL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:KARIN
Other - Middle Name:GOODELL
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:12042 SE SUNNYSIDE ROAD #239
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-516-5321
Mailing Address - Fax:503-477-4274
Practice Address - Street 1:9067 SE HAMILTON LANE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-516-5321
Practice Address - Fax:503-477-4274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist