Provider Demographics
NPI:1649805391
Name:WESTRICH, CHRISTA LEIGH (RD,LD,CNSC)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LEIGH
Last Name:WESTRICH
Suffix:
Gender:F
Credentials:RD,LD,CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 STATE HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:BURFORDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63739-9030
Mailing Address - Country:US
Mailing Address - Phone:573-579-1467
Mailing Address - Fax:
Practice Address - Street 1:326 S BROADVIEW ST STE B
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5703
Practice Address - Country:US
Practice Address - Phone:573-986-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1665133V00000X
IL164007025133V00000X
MO2001031900133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty