Provider Demographics
NPI:1962939769
Name:RICHTER, JOHANNA M (MS, RDN, CD, LDN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:M
Last Name:RICHTER
Suffix:
Gender:F
Credentials:MS, RDN, CD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 NW MARKET ST # 4110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5264
Mailing Address - Country:US
Mailing Address - Phone:206-880-0108
Mailing Address - Fax:
Practice Address - Street 1:100 W HARRISON ST STE 140
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:206-880-0108
Practice Address - Fax:888-789-6982
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007118133V00000X
WADI60850685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered