Provider Demographics
NPI:1710003033
Name:RICHARDS, ELIZABETH SCOTTO (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SCOTTO
Last Name:RICHARDS
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 1:3937 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1306
Mailing Address - Country:US
Mailing Address - Phone:971-563-1460
Mailing Address - Fax:503-288-8972
Practice Address - Street 1:2526 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4222
Practice Address - Country:US
Practice Address - Phone:503-288-7668
Practice Address - Fax:503-288-8972
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROC00703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist