Provider Demographics
NPI:1922474980
Name:WALL, EMILY (MS, RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 TIETON DR
Mailing Address - Street 2:CLINICAL NUTRITION SERVICES
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4003 CREEKSIDE LOOP
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3962
Practice Address - Country:US
Practice Address - Phone:509-573-3875
Practice Address - Fax:509-225-2711
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60592163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered