Provider Demographics
NPI:1528494606
Name:MOORE, CHELSEA LEE (RD, CD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5324
Mailing Address - Country:US
Mailing Address - Phone:425-890-5681
Mailing Address - Fax:
Practice Address - Street 1:4030 ALDERWOOD MALL BLVD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6763
Practice Address - Country:US
Practice Address - Phone:425-776-0803
Practice Address - Fax:425-776-0813
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI.60411675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered