Provider Demographics
NPI:1255742540
Name:TOEPFER, DANIELLE MARIE (RD,LD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:TOEPFER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:KOECKRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1935 N WILLAMETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4418
Mailing Address - Country:US
Mailing Address - Phone:708-269-8618
Mailing Address - Fax:
Practice Address - Street 1:3001 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1530
Practice Address - Country:US
Practice Address - Phone:503-413-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-000954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015584OtherCOMMISSION ON DIETETIC REGISTRATION
ORLD-D-000954OtherBOARD OF LICENSED LICENSED DIETITIANS