Provider Demographics
NPI:1285764084
Name:GOLAB, VICKIE DEL-RAE (LAC)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:DEL-RAE
Last Name:GOLAB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4475 SW SCHOLLS FERRY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1955
Mailing Address - Country:US
Mailing Address - Phone:503-245-2272
Mailing Address - Fax:503-292-0786
Practice Address - Street 1:4475 SW SCHOLLS FERRY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1955
Practice Address - Country:US
Practice Address - Phone:503-245-2272
Practice Address - Fax:503-292-0786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORAC00251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist