Provider Demographics
NPI:1306023312
Name:WOJCIECHOWSKI, JACQUELINE (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:WOJCIECHOWSKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 ROZEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4128
Mailing Address - Country:US
Mailing Address - Phone:267-994-4028
Mailing Address - Fax:
Practice Address - Street 1:3564 EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5408
Practice Address - Country:US
Practice Address - Phone:267-994-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered