Provider Demographics
NPI:1982826897
Name:HENDERSON, JILL M (LD, RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-779-7795
Mailing Address - Fax:740-779-7477
Practice Address - Street 1:4439 ST. RT. 159
Practice Address - Street 2:SUITE 120
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-779-7201
Practice Address - Fax:740-779-7206
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.5280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HEMT 71721Medicare ID - Type Unspecified