Provider Demographics
NPI:1386222958
Name:MATTSON, BETHANY (ND)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:MATTSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NW 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5665
Mailing Address - Country:US
Mailing Address - Phone:503-473-7077
Mailing Address - Fax:
Practice Address - Street 1:1730 SW SKYLINE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2547
Practice Address - Country:US
Practice Address - Phone:503-451-5013
Practice Address - Fax:877-821-9584
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4387175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath