Individual
SAMANTHA ELLEFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD LD CSP
Contact information
Practice address
3181 S.W. SAM JACKSON PARK RD, MAIL CODE: UHS 18, PORTLAND, OR 97239-3098
(503) 418-5257
(503) 418-5317
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE: UHS 18, PORTLAND, OR 97239-3011
(503) 418-5257
(503) 418-5317
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10159207
OR
133V00000X
Registered Dietitian
LD003133
GA
Other
Enumeration date
03/30/2013
Last updated
12/12/2013
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