Provider Demographics
NPI:1255824264
Name:WELLNESS BY DESIGN, LLC
Entity Type:Organization
Organization Name:WELLNESS BY DESIGN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JALEEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KLINK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:971-998-9747
Mailing Address - Street 1:1049 SW BASELINE ST STE D490
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3857
Mailing Address - Country:US
Mailing Address - Phone:971-998-9747
Mailing Address - Fax:503-747-0634
Practice Address - Street 1:12725 SW MILLIKAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1687
Practice Address - Country:US
Practice Address - Phone:971-998-9747
Practice Address - Fax:503-747-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407547NP-PP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care