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Organization

PORTLAND PEDIATRIC NUTRITION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KATHARINE BURTON JEFFCOAT RDN, LD, CLT (DIETITIAN/OWNER)
(503) 997-8897
Entity
Organization

Contact information

Practice address
1730 SW SKYLINE BLVD STE 226, PORTLAND, OR 97221-2549
(971) 319-1288
Mailing address
3230 SW GALE AVE, PORTLAND, OR 97239-1450
(503) 997-8897

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DI60717826
WA
133V00000X
Registered Dietitian
Primary
LD-D-000479
OR
133VN1004X
Pediatric Nutrition Registered Dietitian
LD-D-000479
OR

Other

Enumeration date
09/27/2017
Last updated
03/17/2018
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