Provider Demographics
NPI:1275773103
Name:EDLUND, JENNIFER ROGOW (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROGOW
Last Name:EDLUND
Suffix:
Gender:F
Credentials:ND
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KIM
Other - Last Name:ROGOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:194 MAIN ST
Mailing Address - Street 2:SUITE #216
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-6104
Mailing Address - Country:US
Mailing Address - Phone:802-334-6600
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:SUITE #216
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-6104
Practice Address - Country:US
Practice Address - Phone:802-334-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000138175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath