Provider Demographics
NPI:1083354799
Name:WILLOW, THORN ARTOS MAEB (ND)
Entity Type:Individual
Prefix:DR
First Name:THORN
Middle Name:ARTOS MAEB
Last Name:WILLOW
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:PATRICIA
Other - Last Name:KOERSCHGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16444 SE 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8932
Mailing Address - Country:US
Mailing Address - Phone:971-322-5039
Mailing Address - Fax:
Practice Address - Street 1:16444 SE 135TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8932
Practice Address - Country:US
Practice Address - Phone:971-322-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4443175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath