Provider Demographics
NPI:1700281789
Name:GILLASPY, CADEN (RN, LMT)
Entity Type:Individual
Prefix:
First Name:CADEN
Middle Name:
Last Name:GILLASPY
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:GILLASPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 NE 202ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-8120
Mailing Address - Country:US
Mailing Address - Phone:503-329-1116
Mailing Address - Fax:
Practice Address - Street 1:3701 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4327
Practice Address - Country:US
Practice Address - Phone:503-329-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202105582RN163W00000X
OR20126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist