Healthcare Provider Details

I. General information

NPI: 1841739042
Provider Name (Legal Business Name): KELLY MORGENSEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 SW WASHINGTON SQUARE RD ST 500
PORTLAND OR
97223-4491
US

IV. Provider business mailing address

9020 SW WASHINGTON SQUARE RD ST 500
PORTLAND OR
97223-4491
US

V. Phone/Fax

Practice location:
  • Phone: 503-291-7155
  • Fax: 503-291-7152
Mailing address:
  • Phone: 503-291-7155
  • Fax: 503-291-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: