Provider Demographics
NPI:1508405788
Name:MCDANIEL, JENNIFER LOUISE (MS, RDN, CSSD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MS, RDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2924
Mailing Address - Country:US
Mailing Address - Phone:314-413-1996
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 430
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-413-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO896355133V00000X
MO2003000969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty