Provider Demographics
NPI:1730400706
Name:SODARO, ANDREA ELIZABETH (LAC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:SODARO
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 1:11181 SW BARBER ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7307
Mailing Address - Country:US
Mailing Address - Phone:503-427-2316
Mailing Address - Fax:
Practice Address - Street 1:8600 SW SALISH LN
Practice Address - Street 2:SUITE TWO
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9632
Practice Address - Country:US
Practice Address - Phone:503-427-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist