Provider Demographics
NPI:1932816881
Name:KATIE ROGERS NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:KATIE ROGERS NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD, CD
Authorized Official - Phone:479-200-0581
Mailing Address - Street 1:607 SE 17TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2600
Mailing Address - Country:US
Mailing Address - Phone:971-259-3759
Mailing Address - Fax:971-402-9020
Practice Address - Street 1:2143 NE BROADWAY ST STE 9
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1512
Practice Address - Country:US
Practice Address - Phone:971-259-3759
Practice Address - Fax:971-402-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841752292OtherNPI TYPE 1
ORLD-D-10186235OtherBOARD OF LICENSED DIETITIANS