Provider Demographics
NPI:1598000101
Name:MICHELLE STOBBE
Entity Type:Organization
Organization Name:MICHELLE STOBBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:STOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-819-2904
Mailing Address - Street 1:7110 SW FIR LOOP
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8084
Mailing Address - Country:US
Mailing Address - Phone:503-819-2904
Mailing Address - Fax:
Practice Address - Street 1:7110 SW FIR LOOP
Practice Address - Street 2:SUITE 210
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8084
Practice Address - Country:US
Practice Address - Phone:503-819-2904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153715171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty