Provider Demographics
NPI:1962597625
Name:WADDOUPS, EMILY D (RDCD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:D
Last Name:WADDOUPS
Suffix:
Gender:F
Credentials:RDCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 S 1450 W
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2230
Mailing Address - Country:US
Mailing Address - Phone:801-682-6247
Mailing Address - Fax:
Practice Address - Street 1:288 N 1460 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3231
Practice Address - Country:US
Practice Address - Phone:801-538-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5869829-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered