Provider Demographics
NPI:1902448467
Name:FRIEND, LEAH CASSANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:CASSANDRA
Last Name:FRIEND
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 1:975 SE 11TH AVE APT 620N
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2491
Mailing Address - Country:US
Mailing Address - Phone:503-847-8774
Mailing Address - Fax:
Practice Address - Street 1:837 SW 1ST AVE # 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3307
Practice Address - Country:US
Practice Address - Phone:503-847-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC195711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist