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Individual

ELLEN HOMLONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PC, RD,LD,CDE

Contact information

Practice address
4641 FULTON DR NW, CANTON, OH 44718-2384
(330) 433-6075
Mailing address
2655 HARLAND DR, HUDSON, OH 44236-3257
(234) 380-5250

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
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