Provider Demographics
NPI:1518384387
Name:HODGDON, KRISTEN (RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HODGDON
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 1:3411 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1805
Mailing Address - Country:US
Mailing Address - Phone:513-885-6597
Mailing Address - Fax:
Practice Address - Street 1:3411 BRYANT ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1805
Practice Address - Country:US
Practice Address - Phone:513-885-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7125133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered