# RAVEN ACUPUNCTURE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548763352
- **Authorized official:** SARAH WICKSTROM LAC (ACUPUNCTURIST)
- **Authorized official phone:** (303) 912-5401

## Contact information

- **Practice address:** 120 NE 117TH AVE, VANCOUVER, WA 98684-5020
- **Practice address phone:** (503) 987-0574
- **Mailing address:** 36824 SE SUNSET VIEW RD, WASHOUGAL, WA 98671-6769
- **Mailing address phone:** (303) 912-5401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | 60807373 | WA | Yes |

## Other

- **Enumeration date:** 03/18/2018
- **Last updated:** 03/18/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500679284 | — | OR |