Provider Demographics
NPI:1790331056
Name:SLENKAMP, SHELBY ERIN (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ERIN
Last Name:SLENKAMP
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0945
Mailing Address - Country:US
Mailing Address - Phone:425-422-6895
Mailing Address - Fax:833-563-0471
Practice Address - Street 1:18122 SR 9 STE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5384
Practice Address - Country:US
Practice Address - Phone:425-422-6895
Practice Address - Fax:833-563-0471
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60989156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60989156OtherSTATE OF WASHINGTON DEPARTMENT OF HEALTH
86092126OtherCOMMISSION ON DIETETIC REGISTRATION
WA2140258Medicaid