Individual
MS. SALLIE ANN MCKIBBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
5939 SE BELMONT ST STE C, PORTLAND, OR 97215-1994
(503) 468-7210
(503) 468-5943
Mailing address
5939 SE BELMONT ST STE C, PORTLAND, OR 97215-1994
(503) 468-7210
(503) 468-5943
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC164979
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500696042
—
OR
Enumeration date
05/08/2014
Last updated
07/30/2018
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