Provider Demographics
NPI:1467594630
Name:LEGARE, ELEANOR ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:ELIZABETH
Last Name:LEGARE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1140
Mailing Address - Country:US
Mailing Address - Phone:503-314-9186
Mailing Address - Fax:
Practice Address - Street 1:8514 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1140
Practice Address - Country:US
Practice Address - Phone:503-314-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC185850171100000X
CALM112176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAC185850OtherACUPUNCTURE LICENSE