Stacia Tietje, MS, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

10722 Issued in OH

Practice address

2141 Overlook Rd
Cleveland Heights, OH 44106-5995

Phone

(888) 364-5977

NPI assigned

Oct 8, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emily Program PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Columbus, OH
  • NPI 1669444329
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1255150199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1295 BANDANA BLVD N STE 210",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 OVERLOOK RD",
            "city": "CLEVELAND HEIGHTS",
            "state": "OH",
            "postal_code": "441065995",
            "telephone_number": "888-364-5977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIETJE",
        "first_name": "STACIA",
        "credential": "MS, RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OH",
            "license": "10722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diamond Thompson
• Karla R Thompson, MA, LSW
• King Thompson III
• Michelle Thompson
• Lamarr Derrell Thornton
• Jane Christina Timmons-Mitchell, PH.D.
• Teauna Monae Tobias, COTA/L
• Terry R. Tobias, PH.D.
• Alisha C Todd
• Sanyam Tomar, MD

• Registered Dietitian in Cleveland Heights, OH
• Providers in Cleveland Heights, OH by specialty
• Registered Dietitian in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.