Basic Information
| Provider Information | |||||||||
| NPI: | 1023655826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAUER | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10151 SE SUNNYSIDE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036590880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10151 SE SUNNYSIDE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036590880 | ||||||||
| FaxNumber: | 5035137425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2019 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1201X | 1088854 | N | 133VN1201X | 10224556 | OR | Y |
No ID Information.