Provider Demographics
NPI:1316077126
Name:HAVERTY, MARLEEN (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:MARLEEN
Middle Name:
Last Name:HAVERTY
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 N GREELEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4159
Mailing Address - Country:US
Mailing Address - Phone:503-278-3385
Mailing Address - Fax:503-278-3386
Practice Address - Street 1:5819 N GREELEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4159
Practice Address - Country:US
Practice Address - Phone:503-278-3385
Practice Address - Fax:503-278-3386
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT819175F00000X
ORAC01289171100000X
OR1676175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist