Provider Demographics
NPI:1518642446
Name:RODGERS, JENNA (RD,LD,)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RD,LD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 GREEN RD STE 406
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5716
Mailing Address - Country:US
Mailing Address - Phone:216-407-6278
Mailing Address - Fax:
Practice Address - Street 1:3681 GREEN RD STE 406
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5716
Practice Address - Country:US
Practice Address - Phone:216-407-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered