Provider Demographics
NPI:1093215790
Name:HORVATH, STEPHANIE GRACE (MS, MAED, RDN, CSSD)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GRACE
Last Name:HORVATH
Suffix:
Gender:F
Credentials:MS, MAED, RDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 N EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5622
Mailing Address - Country:US
Mailing Address - Phone:865-340-8033
Mailing Address - Fax:
Practice Address - Street 1:736 N EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5622
Practice Address - Country:US
Practice Address - Phone:865-340-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050708133V00000X
TNLDN0000003169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered