Provider Demographics
NPI:1740535194
Name:VOLM, LAURIE ELLEN (LMT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELLEN
Last Name:VOLM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 SW PETERS RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7622
Mailing Address - Country:US
Mailing Address - Phone:503-639-6963
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD STE 209
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4360
Practice Address - Country:US
Practice Address - Phone:503-313-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist