Provider Demographics
NPI:1104467455
Name:WEBB, KATHERINE MARIE (RDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:WEBB
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:EMMENEGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:2918 SW COLLINS CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6227
Mailing Address - Country:US
Mailing Address - Phone:765-532-8011
Mailing Address - Fax:503-296-2122
Practice Address - Street 1:2918 SW COLLINS CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6227
Practice Address - Country:US
Practice Address - Phone:765-532-8011
Practice Address - Fax:503-296-2122
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86117799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered