Provider Demographics
NPI:1306001581
Name:SAAGE, AUDREY ALEXANDRIA (RDLD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ALEXANDRIA
Last Name:SAAGE
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 W ELM MOTT DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-5302
Mailing Address - Country:US
Mailing Address - Phone:125-482-9262
Mailing Address - Fax:125-482-9262
Practice Address - Street 1:1956 W ELM MOTT DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-5302
Practice Address - Country:US
Practice Address - Phone:125-482-9262
Practice Address - Fax:125-482-9262
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered