Provider Demographics
NPI:1114319498
Name:MOUCH, ERICA (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:MOUCH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 19TH AVE E APT 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4083
Mailing Address - Country:US
Mailing Address - Phone:520-820-9495
Mailing Address - Fax:
Practice Address - Street 1:514 19TH AVE E APT 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4083
Practice Address - Country:US
Practice Address - Phone:520-820-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60660968133V00000X
DCDI100000612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered