Provider Demographics
NPI:1053183806
Name:PERSONALIZED NATURAL WELLNESS LLC
Entity type:Organization
Organization Name:PERSONALIZED NATURAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO, COO
Authorized Official - Prefix:
Authorized Official - First Name:STEFFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTENBERN
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, QMHP, LMSW
Authorized Official - Phone:503-995-6351
Mailing Address - Street 1:PO BOX 2511
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-2511
Mailing Address - Country:US
Mailing Address - Phone:503-995-6351
Mailing Address - Fax:503-676-5317
Practice Address - Street 1:1915 NE STUCKI AVE STE 308
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6951
Practice Address - Country:US
Practice Address - Phone:503-995-6351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty