Provider Demographics
NPI:1831920941
Name:LAIRD, SOPHIA ALEXANDRA (MS, RDN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ALEXANDRA
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 KAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5000
Mailing Address - Country:US
Mailing Address - Phone:512-925-1525
Mailing Address - Fax:
Practice Address - Street 1:1355 W WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1960
Practice Address - Country:US
Practice Address - Phone:823-331-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11946850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered