Provider Demographics
NPI:1922276815
Name:CHILDS, WENDY J (LAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:CHILDS
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 1:2365 GREAR ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2747
Mailing Address - Country:US
Mailing Address - Phone:503-383-9796
Mailing Address - Fax:971-273-6658
Practice Address - Street 1:2365 GREAR ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2747
Practice Address - Country:US
Practice Address - Phone:503-383-9796
Practice Address - Fax:971-273-6658
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150966171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500688715Medicaid