Provider Demographics
NPI:1609247899
Name:LADIZHENSKY, REBECCA (LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LADIZHENSKY
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 1:4125 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3428
Mailing Address - Country:US
Mailing Address - Phone:415-690-0690
Mailing Address - Fax:
Practice Address - Street 1:1971 NW OVERTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1618
Practice Address - Country:US
Practice Address - Phone:971-302-6176
Practice Address - Fax:971-373-5946
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174749171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist