Provider Demographics
NPI:1417130139
Name:SUSEE, MALIA (LAC, MACOM, DIPLOM)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:SUSEE
Suffix:
Gender:F
Credentials:LAC, MACOM, DIPLOM
Other - Prefix:
Other - First Name:GOOD
Other - Middle Name:MEDICINE
Other - Last Name:ACUPUNCTURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MACOM, DIPLOM
Mailing Address - Street 1:1001 SE WATER AVE
Mailing Address - Street 2:STE. 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2147
Mailing Address - Country:US
Mailing Address - Phone:503-517-9987
Mailing Address - Fax:503-517-9903
Practice Address - Street 1:1001 SE WATER AVE
Practice Address - Street 2:STE. 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2147
Practice Address - Country:US
Practice Address - Phone:503-517-9987
Practice Address - Fax:503-517-9903
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist