Provider Demographics
NPI:1538506191
Name:KRAUSE-CAMPOS, ALLISON (LMT)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:KRAUSE-CAMPOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:181 N GRANT ST STE 206B
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3600
Mailing Address - Country:US
Mailing Address - Phone:971-338-8771
Mailing Address - Fax:
Practice Address - Street 1:181 N GRANT ST STE 206B
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3600
Practice Address - Country:US
Practice Address - Phone:971-338-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist