Individual
STEPHANIE LYNN HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
1555 VERNON AVE, BLACKFOOT, ID 83221
(307) 399-0139
Mailing address
1555 VERNON AVE, BLACKFOOT, ID 83221-3050
(307) 399-0139
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-629
ID
Other
Enumeration date
08/17/2010
Last updated
07/07/2011
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