Provider Demographics
NPI:1811404759
Name:HEDRICK, THERESA (RDN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2472
Mailing Address - Country:US
Mailing Address - Phone:814-263-5460
Mailing Address - Fax:
Practice Address - Street 1:119 S BURROWES ST STE 702
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3864
Practice Address - Country:US
Practice Address - Phone:814-263-5460
Practice Address - Fax:814-263-1263
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10165887133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered