Provider Demographics
NPI:1033855192
Name:DILGER, JENNA R (RD, CSP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:R
Last Name:DILGER
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 3RD AVE STE F
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3653
Mailing Address - Country:US
Mailing Address - Phone:812-631-1980
Mailing Address - Fax:812-301-1329
Practice Address - Street 1:671 3RD AVE STE F
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3653
Practice Address - Country:US
Practice Address - Phone:812-631-1980
Practice Address - Fax:812-301-1329
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002904A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered