Healthcare Provider Details

I. General information

NPI: 1881284123
Provider Name (Legal Business Name): COLUMBIA GORGE POSTPARTUM SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1810 B ST
HOOD RIVER OR
97031-1339
US

IV. Provider business mailing address

1810 B ST
HOOD RIVER OR
97031-1339
US

V. Phone/Fax

Practice location:
  • Phone: 541-444-0863
  • Fax:
Mailing address:
  • Phone: 541-444-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH E WATERS
Title or Position: DIRECTOR
Credential: IBCLC, CPPD
Phone: 541-645-3018