Provider Demographics
NPI:1790221489
Name:CASCADE NUTRITION CONSULTING, LLC
Entity Type:Organization
Organization Name:CASCADE NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:360-265-4754
Mailing Address - Street 1:2660 NE HIGHWAY 20
Mailing Address - Street 2:SUITE 610-26
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6402
Mailing Address - Country:US
Mailing Address - Phone:360-265-4754
Mailing Address - Fax:541-358-4987
Practice Address - Street 1:384 SW UPPER TERRACE DR
Practice Address - Street 2:SUITE 213
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1887
Practice Address - Country:US
Practice Address - Phone:360-265-4754
Practice Address - Fax:541-385-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000708261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center