Provider Demographics
NPI:1316184229
Name:HOLST, JESSICA RAE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:HOLST
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:ABERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:902 HOUSTON ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-1094
Mailing Address - Country:US
Mailing Address - Phone:507-765-3898
Mailing Address - Fax:
Practice Address - Street 1:902 HOUSTON ST NW STE 2
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-1094
Practice Address - Country:US
Practice Address - Phone:507-765-3898
Practice Address - Fax:507-765-3898
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3305133V00000X
WI2161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered