Individual
JILL MARIE GORDANIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1508 DIVISION ST STE 15, OREGON CITY, OR 97045-1583
(503) 692-3750
(503) 691-2324
Mailing address
847 NE 19TH AVE STE 300, PORTLAND, OR 97232-2686
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10194419
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2178242
—
WA
05
—
500793387
—
OR
Enumeration date
05/19/2021
Last updated
11/22/2021
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