Provider Demographics
NPI:1730471830
Name:DOOLEY, ERICKA REGINA (LAC)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:REGINA
Last Name:DOOLEY
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 1:5442 NE 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8010
Mailing Address - Country:US
Mailing Address - Phone:503-887-0078
Mailing Address - Fax:971-229-0981
Practice Address - Street 1:2325 E BURNSIDE ST RM 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1655
Practice Address - Country:US
Practice Address - Phone:503-887-0078
Practice Address - Fax:971-229-0981
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC140943171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist