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Individual

MALLORY GAIL LAVIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RDN, LD

Contact information

Practice address
1043 WOLFRUM RD, WELDON SPRING, MO 63304-7625
(314) 517-7669
Mailing address
617 DEREK DR, WENTZVILLE, MO 63385-6843
(636) 866-5593

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2015026928
MO

Other

Enumeration date
01/20/2023
Last updated
01/20/2023
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