Healthcare Provider Details

I. General information

NPI: 1629350210
Provider Name (Legal Business Name): MEGHAN CICHY RDN, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 04/20/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6642 S 193RD PL STE N106
KENT WA
98032-3109
US

IV. Provider business mailing address

6642 S 193RD PL STE N106
KENT WA
98032-3109
US

V. Phone/Fax

Practice location:
  • Phone: 206-569-8002
  • Fax:
Mailing address:
  • Phone: 206-569-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1054337
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: