NPI 1023535440

Gretchen Coleman Wallace, MSRDLDCD

Practitioner Registered Dietitian St. Louis, MO

Practice location

Address: 6 Cardinal Way Suite 900, St. Louis, MO 63102
Phone: (360) 209-2075
Fax: (206) 681-9640
Mailing address: 6 Cardinal Way STE 900, St. Louis, MO 63102

Registered specialties (4)

Registered Dietitian Primary

Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence DI60956654 (WA)

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Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence 2023005984 (MO)

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Dietary & Nutritional Service Providers Taxonomy 133V00000X

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Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence 10235828 (OR)

Registry record

NPI: 1023535440
Entity type: Individual
Sex (as registered): Female
NPI issued: 25 Aug 2017
Record last updated: 8 Nov 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.