Provider Demographics
NPI:1780888305
Name:JAROSZ, GLEN (ND)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:
Last Name:JAROSZ
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 SW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1778
Mailing Address - Country:US
Mailing Address - Phone:503-539-4201
Mailing Address - Fax:
Practice Address - Street 1:8555 SW TUALATIN RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9425
Practice Address - Country:US
Practice Address - Phone:503-691-0901
Practice Address - Fax:503-691-9018
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-245175F00000X
OR1744175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath