MEDICARE: CATHERINE WILLEFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	869188

General Provider Information

NPI Number	:	1356698682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE WILLEFORD

Provider Business Mailing Address
First Line	:	2833 NE SCHUYLER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5058
Country	:	US
Telephone Number	:	503-206-4310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 NE SCHUYLER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-5058
Country	:	US
Telephone Number	:	503-206-4310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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Directions to “ CATHERINE WILLEFORD ” Practice Location

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