Provider Demographics
NPI:1114225471
Name:GOTTFRIED, ALLISON F (RD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:F
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 NW STEWART PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1203
Mailing Address - Country:US
Mailing Address - Phone:541-672-2267
Mailing Address - Fax:541-672-9483
Practice Address - Street 1:2880 NW STEWART PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1203
Practice Address - Country:US
Practice Address - Phone:541-672-2267
Practice Address - Fax:541-672-9483
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1036133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered