Provider Demographics
NPI:1700368420
Name:SENSIBLY SPROUTED LLC
Entity Type:Organization
Organization Name:SENSIBLY SPROUTED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BRITTANY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CD
Authorized Official - Phone:954-249-5131
Mailing Address - Street 1:12 BELLWETHER WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2914
Mailing Address - Country:US
Mailing Address - Phone:360-230-8202
Mailing Address - Fax:360-682-3732
Practice Address - Street 1:12 BELLWETHER WAY STE 223
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2914
Practice Address - Country:US
Practice Address - Phone:360-230-8202
Practice Address - Fax:360-682-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60756162OtherMICHELLE B SMITH: DIETITIAN CERTIFICATION
WA21800751OtherTANYA L GALLO: CERTIFIED DIABETES EDUCATOR
WADI60556488OtherTANYA L GALLO: DIETITIAN CERTIFICATION