Provider Demographics
NPI:1336216308
Name:HEATLIE, HEATHER LOCK (LAC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LOCK
Last Name:HEATLIE
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 1:2204 SE 50TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3817
Mailing Address - Country:US
Mailing Address - Phone:503-314-7871
Mailing Address - Fax:
Practice Address - Street 1:2216 SE 50TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3827
Practice Address - Country:US
Practice Address - Phone:503-314-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC000605171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist