Provider Demographics
NPI:1417793795
Name:SMITH, NATALIE JANE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 SW PFAFFLE ST APT 213
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8419
Mailing Address - Country:US
Mailing Address - Phone:541-225-7662
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8283
Practice Address - Country:US
Practice Address - Phone:503-778-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist