Provider Demographics
NPI:1700070620
Name:DAESCHEL, INGE (RD, LD)
Entity Type:Individual
Prefix:
First Name:INGE
Middle Name:
Last Name:DAESCHEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 BULLEVARD
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9538
Mailing Address - Country:US
Mailing Address - Phone:541-929-4773
Mailing Address - Fax:
Practice Address - Street 1:523 SE WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2834
Practice Address - Country:US
Practice Address - Phone:503-623-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR276133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112061Medicare PIN