Provider Demographics
NPI:1497198329
Name:WALTENBERGER, ROBIN L (RDN LPCC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:L
Last Name:WALTENBERGER
Suffix:
Gender:F
Credentials:RDN LPCC
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:WALTENBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN LPCC
Mailing Address - Street 1:105 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9504
Mailing Address - Country:US
Mailing Address - Phone:330-769-5696
Mailing Address - Fax:
Practice Address - Street 1:140 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9503
Practice Address - Country:US
Practice Address - Phone:330-730-7353
Practice Address - Fax:330-334-2235
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH900303101YP2500X
OHLD 4757133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered