Healthcare Provider Details

I. General information

NPI: 1437414901
Provider Name (Legal Business Name): SOMA WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 MONTGOMERY RD C/O SOMA WELLNESS
CINCINNATI OH
45242-7741
US

IV. Provider business mailing address

9030 MONTGOMERY RD C/O SOMA WELLNESS
CINCINNATI OH
45242-7741
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number4082
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number7357
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number4913
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4082
License Number StateOH

VIII. Authorized Official

Name: JANE E SNYDER
Title or Position: OWNER
Credential: RD
Phone: 513-505-6800