Provider Demographics
NPI:1043566375
Name:JUDSON, ASHLEY (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JUDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 GLOBE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1474
Mailing Address - Country:US
Mailing Address - Phone:440-452-9294
Mailing Address - Fax:
Practice Address - Street 1:1653 GLOBE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1474
Practice Address - Country:US
Practice Address - Phone:440-452-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered