Provider Demographics
NPI:1467027979
Name:LAKE OSWEGO NATURAL HEALTH
Entity Type:Organization
Organization Name:LAKE OSWEGO NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABENDIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:REEBS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-419-7505
Mailing Address - Street 1:1516 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3112
Mailing Address - Country:US
Mailing Address - Phone:503-419-7505
Mailing Address - Fax:503-974-0954
Practice Address - Street 1:1516 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3112
Practice Address - Country:US
Practice Address - Phone:503-419-7505
Practice Address - Fax:503-974-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty