Provider Demographics
NPI:1609928407
Name:RALPH, AMY JO (MS, RD, CD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:RALPH
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9555 670TH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-4713
Mailing Address - Country:US
Mailing Address - Phone:715-962-4025
Mailing Address - Fax:
Practice Address - Street 1:2661 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5407
Practice Address - Country:US
Practice Address - Phone:715-726-3372
Practice Address - Fax:715-726-3629
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI897270133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered