Provider Demographics
NPI:1407572761
Name:WENDT, EMILY (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WENDT
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 1:5500 HEEGE RD
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3505
Mailing Address - Country:US
Mailing Address - Phone:314-884-0305
Mailing Address - Fax:
Practice Address - Street 1:5500 HEEGE RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-3505
Practice Address - Country:US
Practice Address - Phone:314-884-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered