Provider Demographics
NPI:1538766183
Name:HUEBSCH, MELISSA (RDN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HUEBSCH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1367 E BARBARITA AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-8814
Mailing Address - Country:US
Mailing Address - Phone:314-339-3110
Mailing Address - Fax:
Practice Address - Street 1:1525 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-5045
Practice Address - Country:US
Practice Address - Phone:314-339-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
992956133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered