Provider Demographics
NPI:1609583947
Name:MOODY, MELISSA KATHRYN JODA (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHRYN JODA
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHRYN
Other - Last Name:JODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W290N6229 HAWKS LNDG
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9439
Mailing Address - Country:US
Mailing Address - Phone:262-506-4626
Mailing Address - Fax:
Practice Address - Street 1:W290N6229 HAWKS LNDG
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9439
Practice Address - Country:US
Practice Address - Phone:262-506-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86064299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered