Provider Demographics
NPI:1477858330
Name:SPOONEMORE, LEAH M (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:SPOONEMORE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:M
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1624 S I ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5016
Mailing Address - Country:US
Mailing Address - Phone:253-426-6753
Mailing Address - Fax:253-426-6014
Practice Address - Street 1:1624 S I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5016
Practice Address - Country:US
Practice Address - Phone:253-426-6753
Practice Address - Fax:253-426-6014
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60203437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered