Provider Demographics
NPI:1083260467
Name:BAHLING, JESSICA D (RDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:BAHLING
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W BEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3655
Mailing Address - Country:US
Mailing Address - Phone:815-988-9908
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 315C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-6160
Practice Address - Country:US
Practice Address - Phone:815-988-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered