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General NPI Number Information
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NPI Number | 1841752292
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Entity Type | Individual
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Provider Name | KATIE LEIGH ROGERS RD, LD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 2143 NE BROADWAY ST # 9
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City | PORTLAND
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State | OR
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Zip | 97232-1512
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Country | US
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Telephone | 971-259-3759
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Fax | 971-402-9020
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Provider Business Mailing Address
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Address Line | 607 SE 17TH AVE APT 7
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City | PORTLAND
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State | OR
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Zip | 97214-2600
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Country | US
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Telephone | 971-259-3759
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Fax |
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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 | 10186235
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License Number State | OR
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