Provider Demographics
NPI:1003125402
Name:HENDRICKS, SUSANNE H (RD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:H
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1596 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6953
Mailing Address - Country:US
Mailing Address - Phone:843-402-9325
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-577-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered