Provider Demographics
NPI:1982074126
Name:MARQUESS, KATLYN (LAC)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:MARQUESS
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 1:9355 SW DAVIES RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6766
Mailing Address - Country:US
Mailing Address - Phone:509-939-6924
Mailing Address - Fax:
Practice Address - Street 1:16771 SW 12TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6023
Practice Address - Country:US
Practice Address - Phone:509-939-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174642171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist