Active NPI
Susan Rebecca Mall, L.AC
- Acupuncturist
- Troutdale, OR
National Provider Identifier
1386932085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC00329
- Practice address
- 110 E Columbia River Hwy
Troutdale, OR 97060-2068 - Phone
- (503) 407-0397
- NPI assigned
- Jul 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC00329 | OR | Primary |
Addresses
Primary practice location
110 E Columbia River Hwy
Troutdale, OR 97060-2068
Mailing address
5336 NE Ainsworth St
Portland, OR 97218-2316
Phone (503) 407-0397
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC00329 | OR | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310601600000",
"number": "1386932085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5336 NE AINSWORTH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972182316",
"telephone_number": "503-407-0397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E COLUMBIA RIVER HWY",
"city": "TROUTDALE",
"state": "OR",
"postal_code": "970602068",
"telephone_number": "503-407-0397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALL",
"first_name": "SUSAN",
"middle_name": "REBECCA",
"credential": "L.AC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-14",
"last_updated": "2011-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC00329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troutdale, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.