Doctor Name: | MADELYN JO KOONTZ |
NPI Number: | 1265484364 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | 24 |
Business Practice Address: | 3878 Beverly Ave Ne Salem, OR - 973051349 |
Business Phone Number: | 5033636065 |
Business Fax Number: | 5035853523 |
Mailing Address: | 3030 Lawnridge St Sw, ALBANY |
State: | OR |
Postal Code: | 973213444 |
Phone Number: | 5419269216 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 24 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |