Provider Demographics
NPI:1861198111
Name:PHILLIPS, DENISE TALKO (MS, RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:TALKO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, RD,LDN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ALEXANDRIA
Other - Last Name:TALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LDN
Mailing Address - Street 1:120 VALLEY FORGE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PHONEIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-933-3402
Mailing Address - Fax:
Practice Address - Street 1:120 VALLEY FORGE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:PHONEIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-933-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered