Provider Demographics
NPI:1780191924
Name:KIRSTEN ISAKSON, LAC
Entity Type:Organization
Organization Name:KIRSTEN ISAKSON, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-544-5922
Mailing Address - Street 1:6738 SE RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:971-244-9171
Practice Address - Street 1:7831 SE LAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2193
Practice Address - Country:US
Practice Address - Phone:503-482-7556
Practice Address - Fax:971-244-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center