Provider Demographics
NPI:1144608274
Name:ERICKSON, RACHEL (RD, RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DEER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5659
Mailing Address - Country:US
Mailing Address - Phone:801-361-6679
Mailing Address - Fax:
Practice Address - Street 1:468 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2410
Practice Address - Country:US
Practice Address - Phone:801-504-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7816774-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered