Provider Demographics
NPI:1922307016
Name:STOBBE, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:STOBBE
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 1:21887 SW SHERWOOD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9412
Mailing Address - Country:US
Mailing Address - Phone:503-625-0500
Mailing Address - Fax:503-625-0119
Practice Address - Street 1:21887 SW SHERWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9412
Practice Address - Country:US
Practice Address - Phone:503-625-0500
Practice Address - Fax:503-625-0119
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR153715AC171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist