Healthcare Provider Details

I. General information

NPI: 1013542422
Provider Name (Legal Business Name): HEATHER BAHRT REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY MS- 315C2HIN
TACOMA WA
98405-4234
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY MS- 315C2HIN
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-2541
  • Fax: 253-403-1845
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: