Provider Demographics
NPI:1316138381
Name:POOL, LISA R (LAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:POOL
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 1:119 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4901
Mailing Address - Country:US
Mailing Address - Phone:503-474-7446
Mailing Address - Fax:866-454-3484
Practice Address - Street 1:119 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4901
Practice Address - Country:US
Practice Address - Phone:503-474-7446
Practice Address - Fax:866-454-3484
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist