Provider Demographics
NPI:1952517146
Name:DODSON, DENISE LESLIE (RD, CD, CLC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LESLIE
Last Name:DODSON
Suffix:
Gender:F
Credentials:RD, CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 S. 11TH ST.
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1513
Mailing Address - Country:US
Mailing Address - Phone:507-895-6822
Mailing Address - Fax:
Practice Address - Street 1:HOUSE OF WELLNESS
Practice Address - Street 2:S 2845 WHITE EAGLE RD
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-355-1240
Practice Address - Fax:608-356-7152
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1521-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered