Provider Demographics
NPI:1265205389
Name:KLINGENSMITH, HEATHER (RD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KLINGENSMITH
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 1:3318 SANTA FE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4240
Mailing Address - Country:US
Mailing Address - Phone:719-287-1645
Mailing Address - Fax:
Practice Address - Street 1:3318 SANTA FE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-4240
Practice Address - Country:US
Practice Address - Phone:719-287-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86035124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered