Provider Demographics
NPI:1194160531
Name:KOLBJORN, SEDA ELIAM (LMT)
Entity type:Individual
Prefix:
First Name:SEDA
Middle Name:ELIAM
Last Name:KOLBJORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:BEDSOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2100 NE BROADWAY ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-719-5000
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST
Practice Address - Street 2:SUITE 225
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-719-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist