Individual
JACQUE DEVORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, MPH, LD
Contact information
Practice address
6725 SE 19TH AVE, PORTLAND, OR 97202-5635
(503) 753-4561
Mailing address
6725 SE 19TH AVE, PORTLAND, OR 97202-5635
(503) 753-4561
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD D 10151892
OR
133VN1004X
Pediatric Nutrition Registered Dietitian
LD D 10151892
OR
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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