Provider Demographics
NPI:1326522772
Name:REESE, ASHLEY DAWN (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:REESE
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 1:19 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-8912
Mailing Address - Country:US
Mailing Address - Phone:570-898-4938
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-275-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA999307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered