Provider Demographics
NPI:1457882086
Name:KOLLATT, REBECCA (DIETITIAN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOLLATT
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PORCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1609
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1609
Mailing Address - Country:US
Mailing Address - Phone:985-230-3653
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:NUTRITIONAL SERVICES
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6618
Practice Address - Fax:985-230-7080
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered