Provider Demographics
NPI:1538117759
Name:CLAYDON, ELIZABETH J (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:CLAYDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:STE 310
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-3700
Mailing Address - Country:US
Mailing Address - Phone:513-245-3444
Mailing Address - Fax:513-245-3449
Practice Address - Street 1:3120 BURNET AVE
Practice Address - Street 2:STE 306
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3091
Practice Address - Country:US
Practice Address - Phone:513-475-8200
Practice Address - Fax:513-475-8201
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHLD1587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO0299764OtherRRMEDICARE
OHPO0299764OtherRRMEDICARE