Provider Demographics
NPI:1073055240
Name:WEYRAUCH, JENNIFER (MA, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEYRAUCH
Suffix:
Gender:F
Credentials:MA, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHISPERING WOODS RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-6101
Mailing Address - Country:US
Mailing Address - Phone:860-881-7360
Mailing Address - Fax:
Practice Address - Street 1:28 WHISPERING WOODS RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-6101
Practice Address - Country:US
Practice Address - Phone:860-881-7360
Practice Address - Fax:860-467-6062
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT447133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered