Provider Demographics
NPI:1790443968
Name:GESCHKE - LAGROU, CHRISTINA (RDN, CD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GESCHKE - LAGROU
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16724 W LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-9513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16724 W LAUREL DR
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-9513
Practice Address - Country:US
Practice Address - Phone:509-720-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2024-07-25
Deactivation Date:2022-07-03
Deactivation Code:
Reactivation Date:2024-07-25
Provider Licenses
StateLicense IDTaxonomies
WA86085172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered