Provider Demographics
NPI:1811350762
Name:BACH STREIFFER, TAIYA (MPH, RD, CD,)
Entity type:Individual
Prefix:
First Name:TAIYA
Middle Name:
Last Name:BACH STREIFFER
Suffix:
Gender:F
Credentials:MPH, RD, CD,
Other - Prefix:
Other - First Name:TAIYA
Other - Middle Name:
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RD, CD
Mailing Address - Street 1:22 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4905
Mailing Address - Country:US
Mailing Address - Phone:608-333-2883
Mailing Address - Fax:
Practice Address - Street 1:1675 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0002
Practice Address - Country:US
Practice Address - Phone:608-263-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2569-29133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric