Provider Demographics
NPI:1922305945
Name:HUDDART, LESLIE (LAC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HUDDART
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 1:2442 SE 101ST AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3063
Mailing Address - Country:US
Mailing Address - Phone:503-708-9870
Mailing Address - Fax:
Practice Address - Street 1:2442 SE 101ST AVE STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3063
Practice Address - Country:US
Practice Address - Phone:503-708-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC 153196171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist