Provider Demographics
NPI:1407728249
Name:SULESKI, AMY KRISTIN (LAC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:KRISTIN
Last Name:SULESKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:KRISTIN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3526 NE 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:503-335-9440
Mailing Address - Fax:503-493-7281
Practice Address - Street 1:3526 NE 57TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213
Practice Address - Country:US
Practice Address - Phone:503-335-9440
Practice Address - Fax:503-493-7281
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC225945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist