Provider Demographics
NPI:1013064666
Name:HOEDEBECKE, SALLY SIEFERT (MS, RD, LD, FADA)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:SIEFERT
Last Name:HOEDEBECKE
Suffix:
Gender:F
Credentials:MS, RD, LD, FADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 PRIESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-2005
Mailing Address - Country:US
Mailing Address - Phone:410-688-5312
Mailing Address - Fax:
Practice Address - Street 1:5158 BLACK HAWK RD BLDG E1930
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21010-5403
Practice Address - Country:US
Practice Address - Phone:410-436-5388
Practice Address - Fax:410-436-3665
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered