Healthcare Provider Details

I. General information

NPI: 1275242653
Provider Name (Legal Business Name): DELANEY ROSE SUMP MS, RD, CPT, NBCHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 LUCIER AVE NE
SAINT PAUL OR
97137-0015
US

IV. Provider business mailing address

4265 LUCIER AVE NE
SAINT PAUL OR
97137-0015
US

V. Phone/Fax

Practice location:
  • Phone: 503-476-4550
  • Fax:
Mailing address:
  • Phone: 503-476-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3696492
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86291664
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: