Healthcare Provider Details

I. General information

NPI: 1326105297
Provider Name (Legal Business Name): SUZANNE M HENRICK M.S., R.D., CD-N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BERKELEY ST
NORWALK CT
06850-3916
US

IV. Provider business mailing address

9 BERKELEY ST
NORWALK CT
06850-3916
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-2457
  • Fax:
Mailing address:
  • Phone: 203-853-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000497
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: