Provider Demographics
NPI:1184887994
Name:HEIDENREICH, GRETCHEN KATHLEEN (RD, LD)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:KATHLEEN
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:11074 CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8725
Mailing Address - Country:US
Mailing Address - Phone:317-851-8282
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1782
Practice Address - Country:US
Practice Address - Phone:317-851-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001861A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered