Provider Demographics
NPI:1154740090
Name:TYLER, COLLEEN ELIZABETH GOODWIN (ND)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELIZABETH GOODWIN
Last Name:TYLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:233 E HISTORIC COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2078
Mailing Address - Country:US
Mailing Address - Phone:541-740-7075
Mailing Address - Fax:
Practice Address - Street 1:233 E HISTORIC COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2078
Practice Address - Country:US
Practice Address - Phone:541-740-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1994175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath