Provider Demographics
NPI:1639671928
Name:HAAK BECK, LEAH RAE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:RAE
Last Name:HAAK BECK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RAE
Other - Last Name:HAAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:835 SE BISHOP BLVD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5512
Mailing Address - Country:US
Mailing Address - Phone:509-336-7543
Mailing Address - Fax:
Practice Address - Street 1:835 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5512
Practice Address - Country:US
Practice Address - Phone:509-336-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DI60614169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered