Provider Demographics
NPI:1184085144
Name:LAMB, ALISSA (LAC, MSAOM)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:LAMB
Suffix:
Gender:F
Credentials:LAC, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 N MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1646
Mailing Address - Country:US
Mailing Address - Phone:415-646-5605
Mailing Address - Fax:
Practice Address - Street 1:2720 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3160
Practice Address - Country:US
Practice Address - Phone:971-302-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR203207171100000X
OR21493172M00000X
WA61111651171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172M00000XOther Service ProvidersMechanotherapist