Provider Demographics
NPI:1003528886
Name:LETHEMON, JACQUELINE (RDN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LETHEMON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:PRIGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9037 PERRIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-5903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29200 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2228
Practice Address - Country:US
Practice Address - Phone:734-523-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1082991133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered