Provider Demographics
NPI:1982791588
Name:SMITH, CLARISSA (LAC)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:SMITH
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 1:6905 N FENWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5305
Mailing Address - Country:US
Mailing Address - Phone:503-227-3304
Mailing Address - Fax:
Practice Address - Street 1:1920 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1504
Practice Address - Country:US
Practice Address - Phone:503-417-1774
Practice Address - Fax:503-222-3339
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist