Provider Demographics
NPI:1184336562
Name:SMITH, TONIA DENISE CONGO REEVES (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:TONIA
Middle Name:DENISE CONGO REEVES
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8922
Mailing Address - Country:US
Mailing Address - Phone:513-403-7599
Mailing Address - Fax:
Practice Address - Street 1:31 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8922
Practice Address - Country:US
Practice Address - Phone:513-403-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X
OH10012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator