Provider Demographics
NPI:1447609128
Name:NORTHWEST HEALTH SPECIALTIES
Entity Type:Organization
Organization Name:NORTHWEST HEALTH SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:541-791-6052
Mailing Address - Street 1:7121 SW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1907
Mailing Address - Country:US
Mailing Address - Phone:541-791-6052
Mailing Address - Fax:360-841-7672
Practice Address - Street 1:16703 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4300
Practice Address - Country:US
Practice Address - Phone:541-791-6052
Practice Address - Fax:360-841-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60416884171100000X
WAAC60603307171100000X
WANT60416820175F00000X
WANT60624606175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty