Provider Demographics
NPI:1225696834
Name:FREDENBERG, LINDA KAY (RD LN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAY
Last Name:FREDENBERG
Suffix:
Gender:F
Credentials:RD LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1297 BURNS WAY STE 3B
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3162
Mailing Address - Country:US
Mailing Address - Phone:406-751-6728
Mailing Address - Fax:406-758-3263
Practice Address - Street 1:1297 BURNS WAY STE 3B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3162
Practice Address - Country:US
Practice Address - Phone:406-751-6728
Practice Address - Fax:406-758-3263
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-NUTR-LIC-127OtherBOARD OF MEDICAL EXAMINERS
532472OtherACADEMY OF NUTRITION AND DIETETICS