Provider Demographics
NPI:1326716325
Name:NEW LEAF NUTRITION COUNSELING, PLLC
Entity Type:Organization
Organization Name:NEW LEAF NUTRITION COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CD, CEDRD
Authorized Official - Phone:509-391-5888
Mailing Address - Street 1:1752 NW MARKET ST # 4438
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5264
Mailing Address - Country:US
Mailing Address - Phone:509-391-5888
Mailing Address - Fax:
Practice Address - Street 1:9412 1ST AVE NE UNIT 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2707
Practice Address - Country:US
Practice Address - Phone:509-391-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty