Provider Demographics
NPI:1609018605
Name:BAXTER, LEAH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 NEW GERMANY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERHILL
Mailing Address - State:PA
Mailing Address - Zip Code:15958-5212
Mailing Address - Country:US
Mailing Address - Phone:814-241-7690
Mailing Address - Fax:
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4305
Practice Address - Country:US
Practice Address - Phone:814-534-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered