Individual
SUMNER L BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH, RD, CSSD
Contact information
Practice address
1111 NE 99TH AVE, SUITE 301, PORTLAND, OR 97220-9428
(503) 963-2707
(503) 963-2802
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
987508
CA
133V00000X
Registered Dietitian
Primary
LD-D-10169435
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065312
—
WA
05
—
500714219
—
OR
Enumeration date
08/23/2011
Last updated
10/14/2016
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