Provider Demographics
NPI:1952611493
Name:DONNELLY, JOANNA (LAC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4072
Mailing Address - Country:US
Mailing Address - Phone:503-819-4680
Mailing Address - Fax:503-961-8035
Practice Address - Street 1:2929 SW MULTNOMAH BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4072
Practice Address - Country:US
Practice Address - Phone:503-819-4680
Practice Address - Fax:503-961-8035
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00595171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist