Individual
STEPHANIE LYNN MAXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1935 MEDICAL DISTRICT DR, CLINICAL NUTRITION, DALLAS, TX 75235-7701
(214) 456-5698
(214) 456-6287
Mailing address
6024 VICTOR ST, DALLAS, TX 75214-5602
(214) 604-7876
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT80967
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00983946
REGISTERED DIETITIAN
—
01
—
DT80967
LICENSED DIETITIAN
TX
Enumeration date
10/31/2008
Last updated
10/31/2008
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