Individual
MADELYN JO KOONTZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
3878 BEVERLY AVE NE, SALEM, OR 97305-1349
(503) 363-6065
(503) 585-3523
Mailing address
3030 LAWNRIDGE ST SW, ALBANY, OR 97321-3444
(541) 926-9216
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
24
OR
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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