Provider Demographics
NPI:1760732416
Name:GOEDKOOP, SONJA (RD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:GOEDKOOP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:4TH FLOOR, MGH WEIGHT CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-726-4400
Mailing Address - Fax:617-724-6565
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:4TH FLOOR, MGH WEIGHT CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-4400
Practice Address - Fax:617-724-6565
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1060934133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered