Provider Demographics
NPI:1679993240
Name:LAUDER, CLAIRE J (LMT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:J
Last Name:LAUDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 NW VAUGHN ST
Mailing Address - Street 2:#3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2321
Mailing Address - Country:US
Mailing Address - Phone:971-276-7704
Mailing Address - Fax:
Practice Address - Street 1:1815 NW FLANDERS ST
Practice Address - Street 2:L102 & 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2060
Practice Address - Country:US
Practice Address - Phone:503-683-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist