Provider Demographics
NPI:1982029641
Name:GROSVENOR, LINDSAY REAY (RD)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:REAY
Last Name:GROSVENOR
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 1:1108 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4305
Mailing Address - Country:US
Mailing Address - Phone:541-889-7041
Mailing Address - Fax:541-823-9400
Practice Address - Street 1:1108 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4305
Practice Address - Country:US
Practice Address - Phone:541-889-7041
Practice Address - Fax:541-823-9400
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
895201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered