Provider Demographics
NPI:1154547859
Name:PLATT, ELIZABETH CHRISTINE KERN (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE KERN
Last Name:PLATT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 SE SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5747
Mailing Address - Country:US
Mailing Address - Phone:503-939-2796
Mailing Address - Fax:
Practice Address - Street 1:8933 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3003
Practice Address - Country:US
Practice Address - Phone:503-939-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist