Provider Demographics
NPI:1730671363
Name:GIROUX, DENISE (MPH, MS, RD, LD,)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GIROUX
Suffix:
Gender:F
Credentials:MPH, MS, RD, LD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 J D ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3494
Mailing Address - Country:US
Mailing Address - Phone:330-309-1646
Mailing Address - Fax:
Practice Address - Street 1:256 JAMES ST
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-1147
Practice Address - Country:US
Practice Address - Phone:330-309-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1493133V00000X
OH893623133V00000X
WV1601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA173-671363Medicaid