Individual
CONNIE L LIAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
7150 SW DARTMOUTH ST., TIGARD, OR 97223
(503) 968-3480
(503) 227-4589
Mailing address
2701 NW VAUGHN ST, SUITE 360, PORTLAND, OR 97210
(503) 227-0671
(503) 227-4589
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDD000122
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654435
—
OR
Enumeration date
07/11/2012
Last updated
10/19/2018
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