Provider Demographics
NPI:1588041081
Name:COLUMBIA GORGE NATUROPATHY
Entity Type:Organization
Organization Name:COLUMBIA GORGE NATUROPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-270-0483
Mailing Address - Street 1:7027 SE 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7122
Mailing Address - Country:US
Mailing Address - Phone:971-270-0483
Mailing Address - Fax:
Practice Address - Street 1:233 E COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2078
Practice Address - Country:US
Practice Address - Phone:971-270-0483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2067175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty