Provider Demographics
NPI:1538735105
Name:SOOTS, MARY LOURDES (MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOURDES
Last Name:SOOTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 SW TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7010
Mailing Address - Country:US
Mailing Address - Phone:503-803-4922
Mailing Address - Fax:
Practice Address - Street 1:12120 SW TRAIL PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7010
Practice Address - Country:US
Practice Address - Phone:503-803-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHCI010402171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter