Provider Demographics
NPI:1881335990
Name:SEVIN, COLLEEN M (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:SEVIN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 S CALEB DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5708
Mailing Address - Country:US
Mailing Address - Phone:985-640-8928
Mailing Address - Fax:
Practice Address - Street 1:1700 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8062
Practice Address - Country:US
Practice Address - Phone:985-646-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered