Individual
LILA DERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ND
Contact information
Practice address
4035 SE 52ND AVE STE B, PORTLAND, OR 97206
(503) 447-7757
(503) 436-7072
Mailing address
4035 SE 52ND AVE STE B, PORTLAND, OR 97206-3913
(503) 447-7757
(503) 436-7072
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
4181
OR
Other
Enumeration date
09/18/2018
Last updated
10/28/2019
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