Provider Demographics
NPI:1659754265
Name:WEST, LETICIA KIMBERLY (CLC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:KIMBERLY
Last Name:WEST
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NE STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3573
Mailing Address - Country:US
Mailing Address - Phone:706-254-8916
Mailing Address - Fax:
Practice Address - Street 1:611 NE STAFFORD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3573
Practice Address - Country:US
Practice Address - Phone:706-254-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula