Provider Demographics
NPI:1578823258
Name:GALL, STEPHANIE B (DCN, RD, CD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:B
Last Name:GALL
Suffix:
Gender:F
Credentials:DCN, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PIERCE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FERRISBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05473-7113
Mailing Address - Country:US
Mailing Address - Phone:720-975-4013
Mailing Address - Fax:
Practice Address - Street 1:190 PIERCE LN
Practice Address - Street 2:
Practice Address - City:NORTH FERRISBURGH
Practice Address - State:VT
Practice Address - Zip Code:05473-7113
Practice Address - Country:US
Practice Address - Phone:720-975-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered