Provider Demographics
NPI:1760116891
Name:HOLECKO, MEGHAN KATHRYN (RD, LD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KATHRYN
Last Name:HOLECKO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KATHRYN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:215 W BOWERY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-543-1569
Mailing Address - Fax:330-543-3677
Practice Address - Street 1:215 W BOWERY ST BLDG 5TH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-543-1569
Practice Address - Fax:330-543-3677
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH86030459OtherCOMMISSION ON DIETETIC REGISTRATION
OHTJ306972OtherDRIVER LICENSE
OHLD.08778OtherSTATE MEDICAL BOARD OF OHIO