Provider Demographics
NPI:1881185924
Name:KNUDSEN, MATTHEW DANIEL (ND, MSCN, LMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANIEL
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:ND, MSCN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6491 SW CAPITOL HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1939
Mailing Address - Country:US
Mailing Address - Phone:503-504-2153
Mailing Address - Fax:
Practice Address - Street 1:3025 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4858
Practice Address - Country:US
Practice Address - Phone:503-552-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath