Individual
STEPHANIE NICOLE SOUTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1353 N WESTMORELAND RD BLDG F, DALLAS, TX 75211-1655
(214) 333-7091
Mailing address
18777 MIDWAY RD APT 1310, DALLAS, TX 75287-2742
(817) 891-8722
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DT80516
TX
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT80516
TX
Other
Enumeration date
08/01/2007
Last updated
01/16/2009
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