Provider Demographics
NPI:1992015713
Name:REITZ, CHERYL L (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:REITZ
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:WOLLENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-986-1309
Mailing Address - Fax:216-986-1191
Practice Address - Street 1:9500 EUCLID AVE.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-986-1309
Practice Address - Fax:216-986-1191
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 6571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered