Provider Demographics
NPI:1669441382
Name:BABSON, JODY LOUISE (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LOUISE
Last Name:BABSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 SE STARK ST
Mailing Address - Street 2:SUITE A8
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3377
Mailing Address - Country:US
Mailing Address - Phone:503-674-1254
Mailing Address - Fax:503-674-1267
Practice Address - Street 1:24700 SE STARK ST
Practice Address - Street 2:SUITE A8
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3377
Practice Address - Country:US
Practice Address - Phone:503-674-1254
Practice Address - Fax:503-674-1267
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORN/AMedicaid
ORN/AMedicaid
OR114164Medicare ID - Type Unspecified