Provider Demographics
NPI:1346997772
Name:BAILEY, COLLEEN ELIZABETH (MS, RDN, LD)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N 6TH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1914
Mailing Address - Country:US
Mailing Address - Phone:614-881-0446
Mailing Address - Fax:
Practice Address - Street 1:840 N 6TH ST STE 3A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1914
Practice Address - Country:US
Practice Address - Phone:614-881-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09516133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86175731OtherCOMMISSION ON DIETETIC REGISTRATION ID
OHLD.09516OtherSTATE MEDICAL BOARD OF OHIO