Provider Demographics
NPI:1962776864
Name:KIRKENDALL, CLAIRE JEANETTE (LAC, RN)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:JEANETTE
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:'JENNY'
Other - Middle Name:
Other - Last Name:KIRKENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 E POWELL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7622
Mailing Address - Country:US
Mailing Address - Phone:503-804-0687
Mailing Address - Fax:
Practice Address - Street 1:123 E POWELL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7622
Practice Address - Country:US
Practice Address - Phone:503-804-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist