Provider Demographics
NPI:1073712857
Name:SCALES, JENNIFER (RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-3350
Mailing Address - Country:US
Mailing Address - Phone:641-752-4525
Mailing Address - Fax:641-752-1703
Practice Address - Street 1:802 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-3350
Practice Address - Country:US
Practice Address - Phone:641-752-4525
Practice Address - Fax:641-752-1703
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA968OtherGROUP ID MEDICARE
IAIA968OtherGROUP ID MEDICARE