Provider Demographics
NPI:1679607782
Name:SACCOMANNO, SUSAN DANE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DANE
Last Name:SACCOMANNO
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 SE 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3231
Mailing Address - Country:US
Mailing Address - Phone:503-799-4663
Mailing Address - Fax:503-914-1659
Practice Address - Street 1:506 SW 6TH AVE
Practice Address - Street 2:SUITE #801
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1533
Practice Address - Country:US
Practice Address - Phone:503-799-4663
Practice Address - Fax:503-914-1659
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01026171100000X
OR1527175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist