Provider Demographics
NPI:1952007478
Name:LAREAUX BEAUTY & WELLNESS
Entity Type:Organization
Organization Name:LAREAUX BEAUTY & WELLNESS
Other - Org Name:MADAME LAREAUX BEAUTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEQOUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-380-8995
Mailing Address - Street 1:4701 NE KILLINGSWORTH ST APT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1989
Mailing Address - Country:US
Mailing Address - Phone:971-380-8995
Mailing Address - Fax:
Practice Address - Street 1:2225 LLOYD CTR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1315
Practice Address - Country:US
Practice Address - Phone:971-380-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty