Provider Demographics
NPI:1881070936
Name:SALT LAKE NUTRICOACHING LLC
Entity type:Organization
Organization Name:SALT LAKE NUTRICOACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:801-815-7301
Mailing Address - Street 1:1270 W SPRINGSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7929
Mailing Address - Country:US
Mailing Address - Phone:801-815-7301
Mailing Address - Fax:
Practice Address - Street 1:7430 S CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6160
Practice Address - Country:US
Practice Address - Phone:801-981-8795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6784233-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty