Healthcare Provider Details

I. General information

NPI: 1598396855
Provider Name (Legal Business Name): HEIDI HERR KECSKEMETHY MS ED, RDN, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 11/27/2023
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S PROVIDENCE RD
WALLINGFORD PA
19086-6938
US

IV. Provider business mailing address

515 S PROVIDENCE RD
WALLINGFORD PA
19086-6938
US

V. Phone/Fax

Practice location:
  • Phone: 610-506-8354
  • Fax:
Mailing address:
  • Phone: 610-506-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: