Provider Demographics
NPI:1295762482
Name:TRIPP, CATHERINE IVANA (LAC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:IVANA
Last Name:TRIPP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATYA
Other - Middle Name:IVANA
Other - Last Name:TRIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1330 SE 39TH
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-502-3815
Mailing Address - Fax:503-232-7751
Practice Address - Street 1:6925 SE MALLORY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-502-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC00369171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist