Provider Demographics
NPI:1215379565
Name:GOLDSTEIN, LEAH (RD, CD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 BEACON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4324
Mailing Address - Country:US
Mailing Address - Phone:425-478-1092
Mailing Address - Fax:
Practice Address - Street 1:8316 BEACON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4324
Practice Address - Country:US
Practice Address - Phone:425-478-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1067798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered