Provider Demographics
NPI:1124193081
Name:WESTERLUND-RICE, JEAN M (MPH, RD, CD, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:WESTERLUND-RICE
Suffix:
Gender:F
Credentials:MPH, RD, CD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 NW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3332
Mailing Address - Country:US
Mailing Address - Phone:206-205-7259
Mailing Address - Fax:206-205-3286
Practice Address - Street 1:10821 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2225
Practice Address - Country:US
Practice Address - Phone:206-205-7259
Practice Address - Fax:206-205-3286
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8270258Medicaid