1952517146 NPI number — DENISE LESLIE DODSON R.D., C.D., C.L.C.

Table of content: (NPI 1194061002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952517146 NPI number — DENISE LESLIE DODSON R.D., C.D., C.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODSON
Provider First Name:
DENISE
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D., C.D., C.L.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952517146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
539 S. 11TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CRESCENT
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55947-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-895-6822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOUSE OF WELLNESS
Provider Second Line Business Practice Location Address:
S 2845 WHITE EAGLE RD
Provider Business Practice Location Address City Name:
BARABOO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-355-1240
Provider Business Practice Location Address Fax Number:
608-356-7152
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1521-029 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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