Provider Demographics
NPI:1659096915
Name:HOLLOW, JOEL THOMAS (RDN)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:THOMAS
Last Name:HOLLOW
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 MORMON COULEE RD APT 108
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3885
Mailing Address - Country:US
Mailing Address - Phone:262-939-9914
Mailing Address - Fax:
Practice Address - Street 1:3717 MORMON COULEE RD APT 108
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3885
Practice Address - Country:US
Practice Address - Phone:262-939-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3866133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered