Healthcare Provider Details

I. General information

NPI: 1982555173
Provider Name (Legal Business Name): BIG MAMA DOULAS - GRANDMANEM STYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 SE STARK ST
GRESHAM OR
97030-3378
US

IV. Provider business mailing address

1087 SW DOTTIE CT
TROUTDALE OR
97060-1215
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1122
  • Fax:
Mailing address:
  • Phone: 971-512-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LETISHA MCCOY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 971-488-8076