Provider Demographics
NPI:1184345191
Name:KOONS, JORIA VALENE (RD, RDH)
Entity type:Individual
Prefix:
First Name:JORIA
Middle Name:VALENE
Last Name:KOONS
Suffix:
Gender:F
Credentials:RD, RDH
Other - Prefix:
Other - First Name:JORIA
Other - Middle Name:VALENE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:4926 S CORBETT AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3918
Mailing Address - Country:US
Mailing Address - Phone:319-242-1632
Mailing Address - Fax:
Practice Address - Street 1:4926 S CORBETT AVE APT 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3918
Practice Address - Country:US
Practice Address - Phone:319-242-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7985124Q00000X
ORLD-D-10222347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No124Q00000XDental ProvidersDental Hygienist