Individual
LISA TEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
511 SW 10TH AVE STE 1109, PORTLAND, OR 97205-2712
(503) 329-3577
Mailing address
2083 NW JOHNSON ST. #34, PORTLAND, OR 97209
(503) 329-3577
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11219
OR
Other
Enumeration date
11/15/2007
Last updated
11/15/2007
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