Provider Demographics
NPI:1790100030
Name:RAE, SARAH A (RDN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:A
Last Name:RAE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:OPDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:801 BROADWAY STE 800
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4328
Practice Address - Country:US
Practice Address - Phone:206-215-2090
Practice Address - Fax:206-215-3099
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1085434133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1085434OtherREGISTERED DIETITIN