Provider Demographics
NPI:1477536902
Name:ABBOTT, JACQUELINE (DRPH, RDN, DOULA)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DRPH, RDN, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068
Mailing Address - Country:US
Mailing Address - Phone:503-819-8571
Mailing Address - Fax:503-652-5223
Practice Address - Street 1:1511 DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-698-3928
Practice Address - Fax:503-698-4018
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR680133V00000X
OR374J00000X
OR715676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No374J00000XNursing Service Related ProvidersDoula