Provider Demographics
NPI:1710421136
Name:TAGHON, LACY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:
Last Name:TAGHON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3555
Mailing Address - Country:US
Mailing Address - Phone:231-944-5104
Mailing Address - Fax:503-693-1153
Practice Address - Street 1:5035 NE ELAM YOUNG PKWY STE 500
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6473
Practice Address - Country:US
Practice Address - Phone:503-693-1151
Practice Address - Fax:503-693-1153
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22350225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist