Provider Demographics
NPI:1043867369
Name:LEE-WHITNEY, ALYSON JOAN (LAC)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:JOAN
Last Name:LEE-WHITNEY
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 1:2050 SE 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4102
Mailing Address - Country:US
Mailing Address - Phone:503-334-8782
Mailing Address - Fax:
Practice Address - Street 1:3125 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2073
Practice Address - Country:US
Practice Address - Phone:503-758-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC190200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist