Provider Demographics
NPI:1386476315
Name:POWELL, STEPHEN ROSS (RDN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROSS
Last Name:POWELL
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 30TH DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4956
Mailing Address - Country:US
Mailing Address - Phone:573-987-6715
Mailing Address - Fax:
Practice Address - Street 1:3413 30TH DR UNIT 2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4956
Practice Address - Country:US
Practice Address - Phone:573-987-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61438301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered