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General NPI Number Information
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NPI Number | 1790221489
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Entity Type | Organization
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Legal Business Name | CASCADE NUTRITION CONSULTING, LLC
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 384 SW UPPER TERRACE DR SUITE 213
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City | BEND
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State | OR
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Zip | 97702-1887
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Country | US
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Telephone | 360-265-4754
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Fax | 541-385-4987
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Provider Business Mailing Address
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Address Line | 2660 NE HIGHWAY 20 SUITE 610-26
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City | BEND
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State | OR
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Zip | 97701-6402
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Country | US
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Telephone | 360-265-4754
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Fax | 541-358-4987
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Authorized Official
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Title or Position | REGISTERED DIETITIAN / OWNER
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Name | ANDREA BAUMANN
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Credential | RD, LD
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Telephone | 360-265-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 000708
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License Number State | OR
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