Provider Demographics
NPI:1477922797
Name:GOODALE GALEA, JENNIFER (RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOODALE GALEA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GOODALE
Other - Last Name:GALEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CENTER HARBOR
Mailing Address - State:NH
Mailing Address - Zip Code:03226-0727
Mailing Address - Country:US
Mailing Address - Phone:603-344-1997
Mailing Address - Fax:
Practice Address - Street 1:51 GRUNER EXTENSION
Practice Address - Street 2:
Practice Address - City:MOULTONBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03254
Practice Address - Country:US
Practice Address - Phone:603-344-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH356133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered