Provider Demographics
NPI:1821439449
Name:EDLEFSEN, HANNAH LEIGH (BA, LMT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEIGH
Last Name:EDLEFSEN
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 NW FLANDERS ST
Mailing Address - Street 2:SUITE L102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2060
Mailing Address - Country:US
Mailing Address - Phone:541-646-8688
Mailing Address - Fax:
Practice Address - Street 1:1815 NW FLANDERS ST
Practice Address - Street 2:SUITE L102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2060
Practice Address - Country:US
Practice Address - Phone:541-646-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist