Provider Demographics
NPI:1033380696
Name:HOUGH, COLLEEN MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:HOUGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:OGLE/FILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:922 WEYMOUTH BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95536-9573
Mailing Address - Country:US
Mailing Address - Phone:707-786-9601
Mailing Address - Fax:
Practice Address - Street 1:922 WEYMOUTH BLUFF RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:CA
Practice Address - Zip Code:95536-9573
Practice Address - Country:US
Practice Address - Phone:707-786-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804773133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered