Provider Demographics
NPI:1326391665
Name:JASPER, KATIE ANN (MA, CN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:JASPER
Suffix:
Gender:F
Credentials:MA, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 GOODRICH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3133
Mailing Address - Country:US
Mailing Address - Phone:651-278-0479
Mailing Address - Fax:
Practice Address - Street 1:997 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3133
Practice Address - Country:US
Practice Address - Phone:651-278-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist