Sarah Jo Wickstrom, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC160490 Issued in OR

Practice address

18670 Willamette Dr Ste 102
West Linn, OR 97068-1796

Phone

(503) 635-4888

NPI assigned

Nov 30, 2012

Last updated

Nov 6, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Raven Acupuncture PLLC

  • Acupuncturist
  • Vancouver, WA
  • NPI 1548763352
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1174868251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9520 SW BEAVERTON HILLSDALE HWY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970053309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18670 WILLAMETTE DR STE 102",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970681796",
            "telephone_number": "503-635-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "SARAH",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-30",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC160490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• West Linn Vision Center Inc
• Elaine Westfall
• Brian Reid Westover, DMD
• Trina F White, LMT
• Colleen Anne Whyte, RDH
• Shiloh D Wihksne, DC, LLC
• Wild Oak Therapeutic Farm, LLC
• Paxton Marie Wilkinson
• Rachel Wilkinson, PT
• Willamette Clinic, LLC

• Acupuncturist in West Linn, OR
• Providers in West Linn, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.