Provider Demographics
NPI:1346433372
Name:YOUNG, COLLEEN KREIDLER (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:KREIDLER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FORREST AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2218
Mailing Address - Country:US
Mailing Address - Phone:610-664-5858
Mailing Address - Fax:610-664-5250
Practice Address - Street 1:114 FORREST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2218
Practice Address - Country:US
Practice Address - Phone:610-664-5858
Practice Address - Fax:610-664-5250
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered