Provider Demographics
NPI:1659964757
Name:WHITLOCK, MARY (RD, LD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BLEICHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3024 GRANNY SMITH LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3024 GRANNY SMITH LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-7954
Practice Address - Country:US
Practice Address - Phone:513-312-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered