Provider Demographics
NPI:1619935970
Name:SWEET, LAURIE ELLEN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:SWEET
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ELLEN
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:15019 OAK BRIAR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5497
Mailing Address - Country:US
Mailing Address - Phone:630-699-8519
Mailing Address - Fax:
Practice Address - Street 1:2250 STANLEY RD
Practice Address - Street 2:ATTN MCCS-CA, SUITE 276A
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-2640
Practice Address - Country:US
Practice Address - Phone:210-221-6119
Practice Address - Fax:210-221-8360
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05477133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered