Provider Demographics
NPI:1902167075
Name:EHLERS-ANDERSON, LEANNE MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:EHLERS-ANDERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MCADAMS DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-8708
Mailing Address - Country:US
Mailing Address - Phone:936-414-0140
Mailing Address - Fax:936-639-6130
Practice Address - Street 1:203 MCADAMS DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-8708
Practice Address - Country:US
Practice Address - Phone:936-414-0140
Practice Address - Fax:936-639-6130
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered