Provider Demographics
NPI:1093872178
Name:SIEWERT, JESSICA MICHELLE (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:SIEWERT
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:LETARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:12115 BARBARA ANN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-1428
Mailing Address - Country:US
Mailing Address - Phone:586-623-3067
Mailing Address - Fax:
Practice Address - Street 1:44250 DEQUINDRE RD
Practice Address - Street 2:OUTPATIENT DIABETES EDUCATION, 2ND FLOOR
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1002
Practice Address - Country:US
Practice Address - Phone:248-964-0359
Practice Address - Fax:248-964-8050
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P85802Medicare UPIN