Provider Demographics
NPI:1336356138
Name:BOLY, HILAREY (LAC)
Entity Type:Individual
Prefix:MS
First Name:HILAREY
Middle Name:
Last Name:BOLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:FAITH
Other - Last Name:LAFERRIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6223 SW SOUTHWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-998-4281
Mailing Address - Fax:503-515-8099
Practice Address - Street 1:2607 NW THURMAN STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-998-4281
Practice Address - Fax:503-515-8099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2990171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist