Heidi Clark, ND, LAC
Individual provider Active NPI Acupuncturist · Beaverton, OR
NPI 1730456427 · NPPES record last updated May 7, 2014
Key facts
- NPI
- 1730456427
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- AC156029 (OR)
- Practice address
- 4530 SW Hall Blvd
Beaverton, OR 97005-0504 - Phone
- (503) 644-6555
- NPI assigned
- Nov 23, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC156029 | OR | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC156029 | OR | Yes |
Addresses
Primary practice location
4530 SW Hall Blvd
Beaverton, OR 97005-0504
Mailing address
4530 SW Hall Blvd
Beaverton, OR 97005-0504
Phone (503) 644-6555
Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.