Provider Demographics
NPI:1861822082
Name:SOUND NUTRITION DYNAMICS
Entity type:Organization
Organization Name:SOUND NUTRITION DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-239-9186
Mailing Address - Street 1:700 SLEATER KINNEY RD. SE
Mailing Address - Street 2:STE B #227
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5191
Mailing Address - Country:US
Mailing Address - Phone:360-239-9186
Mailing Address - Fax:360-464-9999
Practice Address - Street 1:3702 LONG LAKE DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4056
Practice Address - Country:US
Practice Address - Phone:360-239-9186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty