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NPI Code Detail

MEDICARE: KERRY ELLEN GRETHER

MEDICARE: KERRY ELLEN GRETHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174N00000XLactation Consultant (Non-RN)10265111OR

General Provider Information

NPI Number : 1750246872
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY ELLEN GRETHER
Provider Business Mailing Address
First Line : 3928 NE 13TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1305
Country : US
Telephone Number : 503-956-2579
Fax Number :
Provider Business Practice Location Address
First Line : 3928 NE 13TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1305
Country : US
Telephone Number : 503-956-2579
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2025
Last Update Date : 12/20/2025

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Directions to “ KERRY ELLEN GRETHER ” Practice Location

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