Healthcare Provider Details

I. General information

NPI: 1770780249
Provider Name (Legal Business Name): CLAUDIA E HUMPHREY R.D., L.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 216B
SAINT LOUIS MO
63131-2308
US

IV. Provider business mailing address

15454 LONG CASTLE FOREST CT
CHESTERFIELD MO
63017-7447
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4352
  • Fax: 314-996-4591
Mailing address:
  • Phone: 636-532-2953
  • Fax: 636-532-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2001023549
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: