Provider Demographics
NPI:1770780249
Name:HUMPHREY, CLAUDIA E (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:E
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15454 LONG CASTLE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7447
Mailing Address - Country:US
Mailing Address - Phone:636-532-2953
Mailing Address - Fax:636-532-2953
Practice Address - Street 1:3009 N BALLAS RD STE 216B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2308
Practice Address - Country:US
Practice Address - Phone:314-996-4352
Practice Address - Fax:314-996-4591
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered