Provider Demographics
NPI:1346639721
Name:GLOSS, JESSICA (MS, RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GLOSS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 BEACON ST
Mailing Address - Street 2:APT 104
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4738
Mailing Address - Country:US
Mailing Address - Phone:978-500-6914
Mailing Address - Fax:
Practice Address - Street 1:1477 BEACON ST
Practice Address - Street 2:APT 104
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4738
Practice Address - Country:US
Practice Address - Phone:978-500-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064444133N00000X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic