Provider Demographics
NPI:1104453406
Name:PLISKOW, DANIELLE (MS, LD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PLISKOW
Suffix:
Gender:F
Credentials:MS, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SARAH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2819
Mailing Address - Country:US
Mailing Address - Phone:844-473-2455
Mailing Address - Fax:646-844-6979
Practice Address - Street 1:20 S SARAH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2819
Practice Address - Country:US
Practice Address - Phone:844-473-2455
Practice Address - Fax:646-844-6979
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005483133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2020005483OtherLICENSE DIETITIAN