Provider Demographics
NPI:1295624922
Name:BRENNAN, JENNIFER A (RD, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BRENNAN
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 1:2508 SW KENWILL CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-1447
Mailing Address - Country:US
Mailing Address - Phone:816-729-6754
Mailing Address - Fax:
Practice Address - Street 1:2508 SW KENWILL CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-1447
Practice Address - Country:US
Practice Address - Phone:816-729-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered