Provider Demographics
NPI:1255103669
Name:LIEBER, HEATHER (MS, RDN, CD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LIEBER
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN, CD
Mailing Address - Street 1:4878 S HIGHLAND CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6025
Mailing Address - Country:US
Mailing Address - Phone:801-529-8546
Mailing Address - Fax:
Practice Address - Street 1:4878 S HIGHLAND CIR APT 2
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6025
Practice Address - Country:US
Practice Address - Phone:801-529-8546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11332957-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered