Provider Demographics
NPI:1356563985
Name:GRIES, BETHANY (RD LD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GRIES
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 W WOOSTER ST STE 116
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2646
Mailing Address - Country:US
Mailing Address - Phone:419-373-7699
Mailing Address - Fax:
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-373-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5388133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered