Mom by Lj

NPI #1942734736 in Portland, Oregon

Provider Information

NPI Number: 1942734736
Entity Type: Organization
Organization Name: Mom by Lj
Primary Specialty: Specialist
Enumeration Date: Apr 18, 2017
Last Updated: Apr 18, 2017

Practice Location

Address: 2906 N WILLAMETTE BLVD
City: Portland
State: Oregon
ZIP Code: 97217-4073
Phone: (917) 715-9617

Authorized Official

Name: LISA HULICK, LMT
Title: OWNER
Phone: (917) 715-9617

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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