Provider Demographics
NPI:1467514612
Name:HAYDOCK, CHERIE (MS RD LD CNSD)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:HAYDOCK
Suffix:
Gender:F
Credentials:MS RD LD CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 FRANCE AVE S
Mailing Address - Street 2:SUITE 172
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4702
Mailing Address - Country:US
Mailing Address - Phone:612-418-8194
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:SUITE 833
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-644-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered