Provider Demographics
NPI:1952636631
Name:MCCOMB, SUZANNE DENISE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:DENISE
Last Name:MCCOMB
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 1:1379 SCHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3605
Mailing Address - Country:US
Mailing Address - Phone:636-541-2686
Mailing Address - Fax:
Practice Address - Street 1:6065 HELEN AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:MO
Practice Address - Zip Code:63134-2013
Practice Address - Country:US
Practice Address - Phone:314-522-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008031157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered