Provider Demographics
NPI:1487981148
Name:KOTTER, LUCINDA ROSE (LAC)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ROSE
Last Name:KOTTER
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:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-1690
Mailing Address - Country:US
Mailing Address - Phone:707-239-1687
Mailing Address - Fax:
Practice Address - Street 1:451 MARCH AVE STE A
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3387
Practice Address - Country:US
Practice Address - Phone:707-239-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist