Provider Demographics
NPI:1922996933
Name:CLOVER CLINIC COMMUNITY SERVICES
Entity type:Organization
Organization Name:CLOVER CLINIC COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ULSTED
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-487-6018
Mailing Address - Street 1:114 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3001
Mailing Address - Country:US
Mailing Address - Phone:503-487-6018
Mailing Address - Fax:888-732-4191
Practice Address - Street 1:114 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3001
Practice Address - Country:US
Practice Address - Phone:503-487-6018
Practice Address - Fax:888-732-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty