Healthcare Provider Details

I. General information

NPI: 1366715898
Provider Name (Legal Business Name): HEAD OVER HEELS BIRTH EDUCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 N KELLOGG ST
PORTLAND OR
97203-2151
US

IV. Provider business mailing address

9333 N KELLOGG ST
PORTLAND OR
97203-2151
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-6685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: KRISTA C ESCOBAR
Title or Position: CO-FOUNDER/OWNER
Credential: ICPE, CLE
Phone: 503-310-7407