Provider Demographics
NPI:1073049318
Name:STARR, JENNY L (RDN, CDN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:STARR
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HOUSATONIC AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6089
Mailing Address - Country:US
Mailing Address - Phone:203-668-8665
Mailing Address - Fax:203-572-0749
Practice Address - Street 1:59 HOUSATONIC AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6089
Practice Address - Country:US
Practice Address - Phone:203-668-8665
Practice Address - Fax:203-572-0749
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-567481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered