Individual
ALICE BRYCE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
1748 COUNTRY OAKS LN, THOUSAND OAKS, CA 91362-1900
(206) 898-0453
Mailing address
1748 COUNTRY OAKS LN, THOUSAND OAKS, CA 91362-1900
(206) 898-0453
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
86035426
CA
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86035426
ACADEMY OF NUTRITION AND DIETETICS
—
Enumeration date
08/25/2022
Last updated
08/25/2022
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