Provider Demographics
NPI:1184903734
Name:BECKER, PATRICIA JAN (MS,RD,CNSC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JAN
Last Name:BECKER
Suffix:
Gender:F
Credentials:MS,RD,CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 MONTGOMERY RD
Mailing Address - Street 2:SOMA WELLNESS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7741
Mailing Address - Country:US
Mailing Address - Phone:513-505-6800
Mailing Address - Fax:513-297-9429
Practice Address - Street 1:9030 MONTGOMERY RD
Practice Address - Street 2:SOMA WELLNESS
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7741
Practice Address - Country:US
Practice Address - Phone:513-505-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002537133V00000X
OHLD7357133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered