Organization
RAVEN ACUPUNCTURE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH WICKSTROM LAC (ACUPUNCTURIST)
(303) 912-5401
Entity
Organization
Contact information
Practice address
120 NE 117TH AVE, VANCOUVER, WA 98684-5020
(503) 987-0574
Mailing address
36824 SE SUNSET VIEW RD, WASHOUGAL, WA 98671-6769
(303) 912-5401
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
60807373
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679284
—
OR
Enumeration date
03/18/2018
Last updated
03/18/2018
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