Provider Demographics
NPI:1477921278
Name:KLOSSNER, LAURA (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:KLOSSNER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:IRMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60677
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0900
Mailing Address - Country:US
Mailing Address - Phone:636-893-1356
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR STE 206
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4773
Practice Address - Country:US
Practice Address - Phone:816-505-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered