Provider Demographics
NPI:1649614652
Name:OLTON, STEPHANIE (CLN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:OLTON
Suffix:
Gender:F
Credentials:CLN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ELM ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2193
Mailing Address - Country:US
Mailing Address - Phone:908-389-1013
Mailing Address - Fax:
Practice Address - Street 1:66 ELM ST
Practice Address - Street 2:SUITE 12
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2193
Practice Address - Country:US
Practice Address - Phone:908-389-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist