Provider Demographics
NPI:1669253381
Name:SCHROTH, HALEY (RDN, LD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:SCHROTH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-0202
Mailing Address - Country:US
Mailing Address - Phone:970-381-2360
Mailing Address - Fax:
Practice Address - Street 1:1309 COFFEEN AVE STE 5655
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5777
Practice Address - Country:US
Practice Address - Phone:970-381-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-128510133V00000X
CO133V00000X
WY310133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered