Provider Demographics
NPI:1538515440
Name:HOUSTON, JENNI (CNC)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S ORIGINAL ST APT 8
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2073
Mailing Address - Country:US
Mailing Address - Phone:970-300-1353
Mailing Address - Fax:970-616-6742
Practice Address - Street 1:450 S ORIGINAL ST APT 8
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2073
Practice Address - Country:US
Practice Address - Phone:970-300-1353
Practice Address - Fax:970-616-6742
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist