Individual
ELLEN HOMLONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PC, RD,LD,CDE
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C.1300021
OH
133V00000X
Registered Dietitian
LD4671
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063558294
—
OH
Enumeration date
01/29/2007
Last updated
12/05/2013
Update your record
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