Provider Demographics
NPI:1962005975
Name:SMITH, SARA ASHLEY (LAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:SMITH
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 1:700 N DEBORAH RD STE 270
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2270
Mailing Address - Country:US
Mailing Address - Phone:503-538-5433
Mailing Address - Fax:
Practice Address - Street 1:700 N DEBORAH RD STE 270
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2270
Practice Address - Country:US
Practice Address - Phone:503-538-5433
Practice Address - Fax:503-537-5153
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC202434171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist