Provider Demographics
NPI:1518020254
Name:MICHELLE HOOVER MS MANAGEMENT
Entity type:Organization
Organization Name:MICHELLE HOOVER MS MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:618-334-0402
Mailing Address - Street 1:3540 BLACK OAK LN
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-7034
Mailing Address - Country:US
Mailing Address - Phone:618-334-0402
Mailing Address - Fax:618-659-3948
Practice Address - Street 1:3540 BLACK OAK LN
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-7034
Practice Address - Country:US
Practice Address - Phone:618-334-0402
Practice Address - Fax:618-659-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003233133NN1002X
MO2001023440133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty