Individual
SUSAN VANCLEVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.AC.O.M., L.AC.
Contact information
Practice address
22400 SE STARK ST, GRESHAM, OR 97030-2656
(503) 492-2600
Mailing address
22400 SE STARK ST, GRESHAM, OR 97030-2656
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC01245
OR
Other
Enumeration date
01/06/2009
Last updated
01/06/2009
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