Provider Demographics
NPI:1235414822
Name:MCCUBBINS, ALICIA ANN (ND)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:MCCUBBINS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 NE 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5104
Mailing Address - Country:US
Mailing Address - Phone:360-301-9006
Mailing Address - Fax:
Practice Address - Street 1:2948 NE 156TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5104
Practice Address - Country:US
Practice Address - Phone:360-301-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6044-170175F00000X
WA175F00000X
OR4373175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath