Provider Demographics
NPI:1407543655
Name:DODD, MICHELLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4598 PEBBLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PENINSULA
Mailing Address - State:OH
Mailing Address - Zip Code:44264-9468
Mailing Address - Country:US
Mailing Address - Phone:330-671-7330
Mailing Address - Fax:
Practice Address - Street 1:4598 PEBBLE CREEK CT
Practice Address - Street 2:
Practice Address - City:PENINSULA
Practice Address - State:OH
Practice Address - Zip Code:44264-9468
Practice Address - Country:US
Practice Address - Phone:330-671-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered