Healthcare Provider Details

I. General information

NPI: 1508476466
Provider Name (Legal Business Name): CHRISTINE MARYANN SCHLAGENHAUF RDN, CSOWM, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W129N7055 NORTHFIELD DR BLDG B
MENOMONEE FALLS WI
53051-0538
US

IV. Provider business mailing address

W129N7055 NORTHFIELD DR BLDG B
MENOMONEE FALLS WI
53051-0538
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number817682
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: