Provider Demographics
NPI:1588269815
Name:KOCH, ASHLEY BULLIE (MS, CNS)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BULLIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 NW NORTHRUP STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2684
Mailing Address - Country:US
Mailing Address - Phone:415-404-1915
Mailing Address - Fax:
Practice Address - Street 1:2556 NW NORTHRUP STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2684
Practice Address - Country:US
Practice Address - Phone:415-404-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program