Provider Demographics
NPI:1841072329
Name:TODD, JOSHUA JAMES (RDN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:TODD
Suffix:
Gender:M
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:W4000 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:WI
Mailing Address - Zip Code:53049-1694
Mailing Address - Country:US
Mailing Address - Phone:512-527-4135
Mailing Address - Fax:
Practice Address - Street 1:W4000 LINDEN DR
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:WI
Practice Address - Zip Code:53049-1694
Practice Address - Country:US
Practice Address - Phone:512-527-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86072619133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty