Provider Demographics
NPI:1023629185
Name:LOEHRKE, BETHANY JOY (CPM, LDM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:LOEHRKE
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-1810
Mailing Address - Country:US
Mailing Address - Phone:971-231-5232
Mailing Address - Fax:
Practice Address - Street 1:314 SE BEECH AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7723
Practice Address - Country:US
Practice Address - Phone:503-475-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10209555176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty