Provider Demographics
NPI:1467176776
Name:LASCH, STEPHANIE PATRICIA (RD)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:PATRICIA
Last Name:LASCH
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 1:33 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1781
Mailing Address - Country:US
Mailing Address - Phone:856-230-9345
Mailing Address - Fax:
Practice Address - Street 1:33 MARION AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1781
Practice Address - Country:US
Practice Address - Phone:856-230-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered