Provider Demographics
NPI:1659978641
Name:LAFFERTY, JAIMIE LILLIAN (MS, RDN, CLC)
Entity Type:Individual
Prefix:MS
First Name:JAIMIE
Middle Name:LILLIAN
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MS, RDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 NAAMANS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-1328
Mailing Address - Country:US
Mailing Address - Phone:610-529-6886
Mailing Address - Fax:
Practice Address - Street 1:1033 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3922
Practice Address - Country:US
Practice Address - Phone:610-543-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009173133V00000X
DE0010806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered