Provider Demographics
NPI:1770993545
Name:LAKE OSWEGO HEALTH CENTER
Entity type:Organization
Organization Name:LAKE OSWEGO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N.D
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGHID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-240-4214
Mailing Address - Street 1:470 6TH ST
Mailing Address - Street 2:SUITE #C
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2920
Mailing Address - Country:US
Mailing Address - Phone:503-505-9806
Mailing Address - Fax:503-505-9807
Practice Address - Street 1:470 6TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2920
Practice Address - Country:US
Practice Address - Phone:503-505-9806
Practice Address - Fax:503-505-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1896175F00000X
OR1429175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty