Provider Demographics
NPI:1336267954
Name:MCDANIEL, LEAH C (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 CLIFFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8652
Mailing Address - Country:US
Mailing Address - Phone:817-485-0384
Mailing Address - Fax:817-485-0384
Practice Address - Street 1:5009 THOMPSON TER
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5850
Practice Address - Country:US
Practice Address - Phone:817-485-0384
Practice Address - Fax:817-485-0384
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered