Provider Demographics
NPI:1780617662
Name:MASON, DEEDRA RAE (ND)
Entity type:Individual
Prefix:DR
First Name:DEEDRA
Middle Name:RAE
Last Name:MASON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 WILLAMETTE FALLS DR
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4620
Mailing Address - Country:US
Mailing Address - Phone:503-319-2496
Mailing Address - Fax:
Practice Address - Street 1:2008 WILLAMETTE FALLS DR
Practice Address - Street 2:SUITE 200 A
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4620
Practice Address - Country:US
Practice Address - Phone:503-607-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1178175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath