Provider Demographics
NPI:1629556816
Name:PARRISH, STEPHANIE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PARRISH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:TILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 NW SAMARITAN DRIVE
Mailing Address - Street 2:CLINICAL NUTRITION SERVICES
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3737
Mailing Address - Country:US
Mailing Address - Phone:541-230-8938
Mailing Address - Fax:541-768-5466
Practice Address - Street 1:3600 NW SAMARITAN DRIVE
Practice Address - Street 2:CLINICAL NUTRITION SERVICES
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3737
Practice Address - Country:US
Practice Address - Phone:541-230-8938
Practice Address - Fax:541-768-5466
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86100720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered