Provider Demographics
NPI:1194900233
Name:ANDERSON, LAURA LEA (MS, RD, CSSD)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 PIKA RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9518
Mailing Address - Country:US
Mailing Address - Phone:970-214-8905
Mailing Address - Fax:
Practice Address - Street 1:585 PIKA RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9518
Practice Address - Country:US
Practice Address - Phone:970-214-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO956752133V00000X
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered