Provider Demographics
NPI:1629230016
Name:BECKER, BETTY JO (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY JO
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 LARRY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1433
Mailing Address - Country:US
Mailing Address - Phone:716-693-0325
Mailing Address - Fax:
Practice Address - Street 1:445 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2341
Practice Address - Fax:716-690-2590
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered