Healthcare Provider Details

I. General information

NPI: 1891184073
Provider Name (Legal Business Name): ALLISON GERIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 12/20/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

15518 SE HUGH AVE
MILWAUKIE OR
97267-3729
US

V. Phone/Fax

Practice location:
  • Phone: 503-867-1384
  • Fax:
Mailing address:
  • Phone: 503-880-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10148499
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: