Individual
EMMA ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
12778 SE STARK ST # 125, PORTLAND, OR 97233-1539
(503) 317-3113
Mailing address
4200 NW NORTH RD, PORTLAND, OR 97229-2593
(804) 878-9522
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC196567
OR
Other
Enumeration date
03/08/2020
Last updated
03/08/2020
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