Provider Demographics
NPI:1023569563
Name:HELM, JACLYN MICHELE (MS,RD,CD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MICHELE
Last Name:HELM
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 1:2820 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2112
Mailing Address - Country:US
Mailing Address - Phone:509-252-5792
Mailing Address - Fax:509-340-7323
Practice Address - Street 1:2820 N ASTOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2112
Practice Address - Country:US
Practice Address - Phone:509-252-5792
Practice Address - Fax:509-340-7323
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60704379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered