Provider Demographics
NPI:1457672305
Name:MAAS-DRAKE, LINDA NOREEN (LAC, LMT, LLC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NOREEN
Last Name:MAAS-DRAKE
Suffix:
Gender:F
Credentials:LAC, LMT, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SW PARK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-7807
Mailing Address - Country:US
Mailing Address - Phone:503-445-8888
Mailing Address - Fax:
Practice Address - Street 1:1525 SW PARK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-7807
Practice Address - Country:US
Practice Address - Phone:503-445-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist