Provider Demographics
NPI:1295945343
Name:HARRIS, JUDITH (CERTIFIED DIETITIAN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CERTIFIED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 W 4375 S
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9695
Mailing Address - Country:US
Mailing Address - Phone:801-791-9252
Mailing Address - Fax:
Practice Address - Street 1:288 N 1460 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3231
Practice Address - Country:US
Practice Address - Phone:801-538-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325403-4901133V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered174400000XOther Service ProvidersSpecialist