Individual
STEPHANIE PETIX WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
1033 SW YAMHILL ST, STE 100, PORTLAND, OR 97205-2545
(503) 227-8781
Mailing address
1033 SW YAMHILL ST., STE 100, PORTLAND, OR 97205
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC00575
OR
Other
Enumeration date
11/02/2006
Last updated
01/18/2008
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