Provider Demographics
NPI:1932568458
Name:ISAKSON, KIRSTEN KAREN (LAC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:KAREN
Last Name:ISAKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 SE 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2420
Mailing Address - Country:US
Mailing Address - Phone:503-544-5922
Mailing Address - Fax:
Practice Address - Street 1:4035 SE 52ND AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3913
Practice Address - Country:US
Practice Address - Phone:971-229-2140
Practice Address - Fax:971-244-9171
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175528171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist