Individual
REBECCA MCKEOWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
125 LASALLE RD, WEST HARTFORD, CT 06107-2322
(860) 906-1289
Mailing address
5 N EDGEWOOD RD, NIANTIC, CT 06357-1918
(860) 389-2103
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86012417
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AHW-158751002
PROLIABILITY
CT
Enumeration date
03/01/2016
Last updated
03/01/2016
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