Provider Demographics
NPI:1306274287
Name:LEVENDOSKY, MICHELLE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEVENDOSKY
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 1:16004 SW TUALATIN SHERWOOD RD # 101
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8521
Mailing Address - Country:US
Mailing Address - Phone:503-575-0593
Mailing Address - Fax:503-925-8114
Practice Address - Street 1:16004 SW TUALATIN SHERWOOD RD # 101
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8521
Practice Address - Country:US
Practice Address - Phone:503-575-0593
Practice Address - Fax:503-925-8114
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist