Healthcare Provider Details

I. General information

NPI: 1669441382
Provider Name (Legal Business Name): JODY LOUISE BABSON R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24700 SE STARK ST SUITE A8
GRESHAM OR
97030-3377
US

IV. Provider business mailing address

24700 SE STARK ST SUITE A8
GRESHAM OR
97030-3377
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1254
  • Fax: 503-674-1267
Mailing address:
  • Phone: 503-674-1254
  • Fax: 503-674-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: