Provider Demographics
NPI:1609099977
Name:JETT, SUSAN E (RD, LD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:JETT
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 1:13100 NORTHWEST FWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6310
Mailing Address - Country:US
Mailing Address - Phone:281-343-0367
Mailing Address - Fax:
Practice Address - Street 1:11301 FALLBROOK DR
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4237
Practice Address - Country:US
Practice Address - Phone:713-840-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered