Provider Demographics
NPI:1295470938
Name:DANESHVAR, KATIE MARIE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:201 NE NATALIE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9425
Mailing Address - Country:US
Mailing Address - Phone:936-419-9254
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST STE 6N40
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:844-987-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10208387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered