Provider Demographics
NPI:1770067860
Name:DODD, MELISSA (CCN, IFNCP, CSNC, CW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:CCN, IFNCP, CSNC, CW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LAMON ST
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2611
Mailing Address - Country:US
Mailing Address - Phone:512-820-9329
Mailing Address - Fax:
Practice Address - Street 1:515 LAMON ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2611
Practice Address - Country:US
Practice Address - Phone:512-820-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist