Provider Demographics
NPI:1740985829
Name:HENNIG, THERESA LYNNE (RDN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNNE
Last Name:HENNIG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 WINDSOR RANCH LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4853
Mailing Address - Country:US
Mailing Address - Phone:210-391-7031
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 400B
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2167
Practice Address - Country:US
Practice Address - Phone:210-439-1714
Practice Address - Fax:830-730-5652
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851869133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty