Provider Demographics
NPI:1982843199
Name:HARRISON, KALLI SUSANNAH (ND)
Entity Type:Individual
Prefix:DR
First Name:KALLI
Middle Name:SUSANNAH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 NE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8137
Mailing Address - Country:US
Mailing Address - Phone:503-358-5203
Mailing Address - Fax:
Practice Address - Street 1:4850 NE 40TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8137
Practice Address - Country:US
Practice Address - Phone:503-358-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1098175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath