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General NPI Number Information
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NPI Number | 1083979454
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Entity Type | Individual
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Provider Name | CONNIE L LIAKOS RD, LD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 7150 SW DARTMOUTH ST.
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City | TIGARD
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State | OR
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Zip | 97223
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Country | US
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Telephone | 503-968-3480
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Fax | 503-227-4589
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Provider Business Mailing Address
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Address Line | 2701 NW VAUGHN ST SUITE 360
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City | PORTLAND
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State | OR
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Zip | 97210
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Country | US
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Telephone | 503-227-0671
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Fax | 503-227-4589
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDD000122
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License Number State | OR
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