Individual
KELLY LYNN BAUCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1809 NE 2ND AVE, PORTLAND, OR 97212-3933
(503) 683-2826
Mailing address
1809 NE 2ND AVE, PORTLAND, OR 97212-3933
(503) 683-2826
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC175542
OR
Other
Enumeration date
02/10/2016
Last updated
04/29/2026
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