Provider Demographics
NPI:1477430619
Name:GALLAGHER, COURTNEY (RD, CSSD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4425
Mailing Address - Country:US
Mailing Address - Phone:267-566-6672
Mailing Address - Fax:
Practice Address - Street 1:1289 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4425
Practice Address - Country:US
Practice Address - Phone:267-566-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85570133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered