Provider Demographics
NPI:1700113503
Name:MACHEN, ALLISON (LAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MACHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:MACHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:7454 N MONTEITH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4265
Mailing Address - Country:US
Mailing Address - Phone:360-770-0191
Mailing Address - Fax:
Practice Address - Street 1:7319 N JOHN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4885
Practice Address - Country:US
Practice Address - Phone:503-406-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X374J00000X
ORAC174444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No374J00000XNursing Service Related ProvidersDoula