Provider Demographics
NPI:1417244906
Name:NEEDS, MICHELLE KATHERINE (RDLD)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:KATHERINE
Last Name:NEEDS
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 MILL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9188
Mailing Address - Country:US
Mailing Address - Phone:330-309-6205
Mailing Address - Fax:
Practice Address - Street 1:1121 MILL PARK DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9188
Practice Address - Country:US
Practice Address - Phone:330-309-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD6045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered