Provider Demographics
NPI:1053575241
Name:GESSFORD, DANIELLE LORRAINE (RD,CDCES,LD, CD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LORRAINE
Last Name:GESSFORD
Suffix:
Gender:F
Credentials:RD,CDCES,LD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13761 NW MASON HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-8102
Mailing Address - Country:US
Mailing Address - Phone:503-647-5321
Mailing Address - Fax:
Practice Address - Street 1:19400 NW EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7031
Practice Address - Country:US
Practice Address - Phone:503-617-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR813133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered