Provider Demographics
NPI:1669652459
Name:GRAZILLA, ASHLEY H (RD, LD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:GRAZILLA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:H
Other - Last Name:BOLENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1275 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8273
Mailing Address - Country:US
Mailing Address - Phone:937-393-6100
Mailing Address - Fax:937-393-6229
Practice Address - Street 1:1275 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8273
Practice Address - Country:US
Practice Address - Phone:937-393-6100
Practice Address - Fax:937-393-6229
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL996282133V00000X
OHLD.5951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered