Individual
SUSAN REBECCA MALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC
Contact information
Practice address
110 E COLUMBIA RIVER HWY, TROUTDALE, OR 97060-2068
(503) 407-0397
Mailing address
5336 NE AINSWORTH ST, PORTLAND, OR 97218-2316
(503) 407-0397
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC00329
OR
Other
Enumeration date
07/14/2011
Last updated
07/14/2011
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