Provider Demographics
NPI:1679124473
Name:PICKWORTH, COURTNEY KATHLEEN (ND)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KATHLEEN
Last Name:PICKWORTH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:PICKWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:5936 SOUTHEAST BELMONT STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4858
Mailing Address - Country:US
Mailing Address - Phone:541-638-0870
Mailing Address - Fax:
Practice Address - Street 1:5936 SOUTHEAST BELMONT STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-4858
Practice Address - Country:US
Practice Address - Phone:541-638-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath