Provider Demographics
NPI:1457624421
Name:ROBIDOUX, AMBER M (LAC, LMT, CST)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:ROBIDOUX
Suffix:
Gender:F
Credentials:LAC, LMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1636
Mailing Address - Country:US
Mailing Address - Phone:541-292-0663
Mailing Address - Fax:
Practice Address - Street 1:201 B AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3159
Practice Address - Country:US
Practice Address - Phone:541-292-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC156926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist