Provider Demographics
NPI:1851727291
Name:MARGOLIS, STEPHANIE M (RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1705
Mailing Address - Country:US
Mailing Address - Phone:314-435-2041
Mailing Address - Fax:
Practice Address - Street 1:1605 ANDREW DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1705
Practice Address - Country:US
Practice Address - Phone:314-435-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered