Provider Demographics
NPI:1982014429
Name:SEIBERT, BROOKE (MS, RDN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CANYON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9276
Mailing Address - Country:US
Mailing Address - Phone:971-361-8250
Mailing Address - Fax:
Practice Address - Street 1:204 CANYON CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9276
Practice Address - Country:US
Practice Address - Phone:971-361-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10190614133V00000X
AK185410133V00000X
171M00000X
1076966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171M00000XOther Service ProvidersCase Manager/Care Coordinator