Provider Demographics
NPI:1508280918
Name:WILLAMETTE INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:WILLAMETTE INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SEDLAK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-913-1029
Mailing Address - Street 1:25195 SW PARKWAY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25195 SW PARKWAY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9651
Practice Address - Country:US
Practice Address - Phone:971-245-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty