Provider Demographics
NPI:1659568756
Name:GRIFFIN, EMDEN ROSE (LAC, LMT)
Entity Type:Individual
Prefix:MISS
First Name:EMDEN
Middle Name:ROSE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 NE 4TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4647
Mailing Address - Country:US
Mailing Address - Phone:541-350-0723
Mailing Address - Fax:
Practice Address - Street 1:911 NE 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4647
Practice Address - Country:US
Practice Address - Phone:541-350-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10489174400000X
OR164966171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171100000XOther Service ProvidersAcupuncturist