MEDICARE: DENISE LESLIE DODSON R.D., C.D., C.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1521-029	WI

General Provider Information

NPI Number	:	1952517146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LESLIE DODSON R.D., C.D., C.L.C.

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

Provider Business Practice Location Address
First Line	:	HOUSE OF WELLNESS
Second Line	:	S 2845 WHITE EAGLE RD
City	:	BARABOO
State	:	WI
Zip	:	53913
Country	:	US
Telephone Number	:	608-355-1240
Fax Number	:	608-356-7152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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