Provider Demographics
NPI:1700132800
Name:KLEIN, SCOTT MERRILL (LAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MERRILL
Last Name:KLEIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:MERRILL
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:200 SE 105TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2954
Mailing Address - Country:US
Mailing Address - Phone:503-828-1778
Mailing Address - Fax:707-248-5948
Practice Address - Street 1:200 SE 105TH AVE APT 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2954
Practice Address - Country:US
Practice Address - Phone:503-828-1778
Practice Address - Fax:707-248-5948
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist