Provider Demographics
NPI:1568900280
Name:WARD, TERRI DAWN
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:DAWN
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20541 SW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9513
Mailing Address - Country:US
Mailing Address - Phone:503-332-2669
Mailing Address - Fax:503-218-8989
Practice Address - Street 1:20541 SW 103RD AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9513
Practice Address - Country:US
Practice Address - Phone:503-332-2669
Practice Address - Fax:503-218-8989
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education