Provider Demographics
NPI:1376671719
Name:FROELICH, TERESA REGINE (RD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:REGINE
Last Name:FROELICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 GOOSEBERRY DR
Mailing Address - Street 2:UNIT #601
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6412
Mailing Address - Country:US
Mailing Address - Phone:303-689-5506
Mailing Address - Fax:
Practice Address - Street 1:200 EXEMPLA CIR
Practice Address - Street 2:ATTN: NUTRITION SERVICES DEPT
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-689-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO951257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered