Provider Demographics
NPI:1558695510
Name:LEATON, ERICA ROSE (LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROSE
Last Name:LEATON
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 1:130 NW 19TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2305
Mailing Address - Country:US
Mailing Address - Phone:541-265-8455
Mailing Address - Fax:
Practice Address - Street 1:130 NW 19TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2305
Practice Address - Country:US
Practice Address - Phone:541-265-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01262171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist