Provider Demographics
NPI:1225829799
Name:HAWK, SUSAN (PHD, RD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 ABERDEEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-3103
Mailing Address - Country:US
Mailing Address - Phone:509-899-1834
Mailing Address - Fax:
Practice Address - Street 1:1248 ABERDEEN CT
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-3103
Practice Address - Country:US
Practice Address - Phone:509-899-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered