Provider Demographics
NPI:1659956431
Name:MACKINTOSH, RACHEL (RD LD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 SE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5017
Mailing Address - Country:US
Mailing Address - Phone:503-756-7103
Mailing Address - Fax:
Practice Address - Street 1:5200 S MACADAM AVE STE 580
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3837
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10168416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered