Provider Demographics
NPI:1629498266
Name:SZWARGULSKI, JAMI (RD, LD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:SZWARGULSKI
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62202-0185
Mailing Address - Country:US
Mailing Address - Phone:618-332-3060
Mailing Address - Fax:
Practice Address - Street 1:5900 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2326
Practice Address - Country:US
Practice Address - Phone:618-332-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered