Provider Demographics
NPI:1427105345
Name:STEVENS, KSENIYA A (LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:KSENIYA
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1808
Mailing Address - Country:US
Mailing Address - Phone:541-480-4970
Mailing Address - Fax:
Practice Address - Street 1:124 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1808
Practice Address - Country:US
Practice Address - Phone:541-480-4970
Practice Address - Fax:425-876-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01017171100000X
WAAC60066963171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist