Provider Demographics
NPI:1063550309
Name:MITCHELL, JANENE (LAC)
Entity type:Individual
Prefix:MS
First Name:JANENE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:JANENE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:4727 NE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3107
Mailing Address - Country:US
Mailing Address - Phone:310-945-7815
Mailing Address - Fax:
Practice Address - Street 1:2067 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1515
Practice Address - Country:US
Practice Address - Phone:503-222-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7960171100000X
OR178026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist