Individual
LAINE CELEDON SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2928 SE HAWTHORNE BLVD, SUITE 104, PORTLAND, OR 97214
(540) 850-3848
Mailing address
2928 SE HAWTHORNE, SUITE 104, PORTLAND, OR 97214
(540) 850-3848
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10182142
OR
Other
Enumeration date
03/22/2017
Last updated
07/24/2017
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