Provider Demographics
NPI:1700019916
Name:HIGGINS, MARY JO (LAC)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 SW COAST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3925
Mailing Address - Country:US
Mailing Address - Phone:541-961-6525
Mailing Address - Fax:541-574-0481
Practice Address - Street 1:135 NW 33RD ST APT B1
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-1631
Practice Address - Country:US
Practice Address - Phone:541-961-6525
Practice Address - Fax:541-574-0481
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist