Provider Demographics
NPI:1134938541
Name:BEAVER, HALLIE (LAC)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:BEAVER
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 1:2530 ST PAUL ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5426
Mailing Address - Country:US
Mailing Address - Phone:541-840-5600
Mailing Address - Fax:
Practice Address - Street 1:2205 ELM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2843
Practice Address - Country:US
Practice Address - Phone:360-734-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61624079171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist