Provider Demographics
NPI:1992931869
Name:ECKLUND, KLARA LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:KLARA
Middle Name:LOUISE
Last Name:ECKLUND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25700 SW ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5799
Mailing Address - Country:US
Mailing Address - Phone:503-582-9805
Mailing Address - Fax:
Practice Address - Street 1:25700 SW ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5799
Practice Address - Country:US
Practice Address - Phone:503-582-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16291172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16291OtherSTATE LICENSE