Provider Demographics
NPI:1639318504
Name:MORGAN, WENDA LEE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:WENDA
Middle Name:LEE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 MIDDLEBIE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3541
Mailing Address - Country:US
Mailing Address - Phone:512-335-7500
Mailing Address - Fax:512-324-1396
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:BUILDING D, SUITE 125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-324-1000
Practice Address - Fax:512-324-1396
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06034133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered