Provider Demographics
NPI:1750653648
Name:NORTHWEST NATUROPATHIC CLINC
Entity Type:Organization
Organization Name:NORTHWEST NATUROPATHIC CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LEMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-224-8083
Mailing Address - Street 1:1540 SE CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1130
Mailing Address - Country:US
Mailing Address - Phone:503-224-8083
Mailing Address - Fax:503-224-5883
Practice Address - Street 1:1540 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1130
Practice Address - Country:US
Practice Address - Phone:503-224-8083
Practice Address - Fax:503-224-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59-540175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty