Provider Demographics
NPI:1922277847
Name:COLE, ELIZABETH (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 SE MONROE ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7646
Mailing Address - Country:US
Mailing Address - Phone:503-860-8998
Mailing Address - Fax:503-236-8224
Practice Address - Street 1:2403 SE MONROE ST
Practice Address - Street 2:SUITE A3
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:503-860-8998
Practice Address - Fax:503-236-8224
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1861784035OtherORGANIZATIONAL NPI