Individual
KENDRA J MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3517 NW SAMARITAN DR STE 200, CORVALLIS, OR 97330-3767
(541) 768-6429
(541) 768-6514
Mailing address
3517 NW SAMARITAN DR STE 200, CORVALLIS, OR 97330-3767
(541) 768-6429
(541) 768-6514
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
000900
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
960099
COMMISSION ON DIETETIC REGISTRATION NUMBER
OR
Enumeration date
12/05/2011
Last updated
12/05/2011
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