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General NPI Number Information
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NPI Number | 1386017424
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Entity Type | Individual
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Provider Name | LAURA SLIWOSKI RD
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8307
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Fax | 503-346-8268
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-8307
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Fax | 503-346-8268
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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 | 1073161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDD10218184
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License Number State | OR
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