Provider Demographics
NPI:1699377416
Name:GAMBLE, JODI ANDREA (RD)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANDREA
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANDREA
Other - Last Name:CALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12393 105TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3968
Mailing Address - Country:US
Mailing Address - Phone:520-401-9175
Mailing Address - Fax:
Practice Address - Street 1:12393 105TH PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3968
Practice Address - Country:US
Practice Address - Phone:520-401-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61131421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered