Provider Demographics
NPI:1255309936
Name:BEHNE, LOIS I (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:I
Last Name:BEHNE
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6317
Mailing Address - Country:US
Mailing Address - Phone:740-387-4755
Mailing Address - Fax:740-387-5728
Practice Address - Street 1:1167 INDEPENDENCE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6317
Practice Address - Country:US
Practice Address - Phone:740-387-4755
Practice Address - Fax:740-387-5728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD-197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
BEMT03141Medicare ID - Type Unspecified