Provider Demographics
NPI:1841739042
Name:MORGENSEN, KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:MORGENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 SW WASHINGTON SQUARE RD
Mailing Address - Street 2:ST 500
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4491
Mailing Address - Country:US
Mailing Address - Phone:503-291-7155
Mailing Address - Fax:503-291-7152
Practice Address - Street 1:9020 SW WASHINGTON SQUARE RD
Practice Address - Street 2:ST 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4491
Practice Address - Country:US
Practice Address - Phone:503-291-7155
Practice Address - Fax:503-291-7152
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education