Provider Demographics
NPI:1194175638
Name:KATHERINE ZIEMAN
Entity type:Organization
Organization Name:KATHERINE ZIEMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-784-6203
Mailing Address - Street 1:22400 SE STARK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2656
Mailing Address - Country:US
Mailing Address - Phone:503-492-1221
Mailing Address - Fax:503-907-0098
Practice Address - Street 1:22400 SE STARK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-492-1221
Practice Address - Fax:503-907-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0799175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126669Medicaid