Provider Demographics
NPI:1730271917
Name:HARRIS-TEACH, LINDA ANN (RD, LD)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:HARRIS-TEACH
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 1:3010 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2672
Mailing Address - Country:US
Mailing Address - Phone:563-355-5643
Mailing Address - Fax:
Practice Address - Street 1:719 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2779
Practice Address - Country:US
Practice Address - Phone:309-852-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered