Provider Demographics
NPI:1558146720
Name:COGHLAN, ELLEN (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:COGHLAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 EAST AVE APT B210
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1968
Mailing Address - Country:US
Mailing Address - Phone:440-308-5629
Mailing Address - Fax:
Practice Address - Street 1:230 EAST AVE APT B210
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1968
Practice Address - Country:US
Practice Address - Phone:440-308-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59.002413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered