Provider Demographics
NPI:1578188850
Name:COHEN, REBECCA R (RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:COHEN
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 1:419 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7908
Mailing Address - Country:US
Mailing Address - Phone:603-748-0681
Mailing Address - Fax:877-743-5351
Practice Address - Street 1:419 22ND ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7908
Practice Address - Country:US
Practice Address - Phone:603-748-0681
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86155888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered