Individual
SUZANNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213-3052
(503) 215-6628
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-000313
OR
Other
Enumeration date
01/24/2018
Last updated
04/03/2019
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