Healthcare Provider Details

I. General information

NPI: 1184903734
Provider Name (Legal Business Name): PATRICIA JAN BECKER MS,RD,CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 MONTGOMERY RD SOMA WELLNESS
CINCINNATI OH
45242-7741
US

IV. Provider business mailing address

9030 MONTGOMERY RD SOMA WELLNESS
CINCINNATI OH
45242-7741
US

V. Phone/Fax

Practice location:
  • Phone: 513-505-6800
  • Fax:
Mailing address:
  • Phone: 513-505-6800
  • Fax: 513-297-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002537
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD7357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: