Individual
MINDY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
10167097
OR
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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