MEDICARE: GOLDI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1609648013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDI

Provider Business Mailing Address
First Line	:	4878 S HIGHLAND CIR APT 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6025
Country	:	US
Telephone Number	:	801-529-8546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4878 S HIGHLAND CIR APT 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6025
Country	:	US
Telephone Number	:	801-529-8546
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	HEATHER LIEBER
Credential	:	MS, RDN, CD
Telephone Number	:	801-529-8546

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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