Provider Demographics
NPI:1619334513
Name:HAMMON, LEAH (RDN, CD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HAMMON
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11627 AIRPORT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-8736
Mailing Address - Country:US
Mailing Address - Phone:425-740-3801
Mailing Address - Fax:
Practice Address - Street 1:11627 AIRPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-8736
Practice Address - Country:US
Practice Address - Phone:425-740-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86057340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered