Organization
MISS ALTER EGO SALON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRIE LYNNE KLOTZ (OWNER/OPERATOR)
(503) 206-9472
Entity
Organization
Contact information
Practice address
21185 NW WEST UNION RD, HILLSBORO, OR 97124-8543
(503) 206-9472
Mailing address
21185 NW WEST UNION RD, HILLSBORO, OR 97124-8543
(503) 206-9472
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
—
—
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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