Provider Demographics
NPI:1659481232
Name:HENSLEY, LINDA SUE (RD,CD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:RD,CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-1877
Mailing Address - Country:US
Mailing Address - Phone:765-677-3117
Mailing Address - Fax:765-677-3150
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:120
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-677-3117
Practice Address - Fax:765-677-3150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000188A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered