Provider Demographics
NPI:1689762064
Name:SLAUGHTER, AMBER NADINE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NADINE
Last Name:SLAUGHTER
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 1:15915 S BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-9755
Mailing Address - Country:US
Mailing Address - Phone:503-632-5733
Mailing Address - Fax:
Practice Address - Street 1:415 17TH ST STE 5
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1010
Practice Address - Country:US
Practice Address - Phone:503-544-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist