Provider Demographics
NPI:1710430251
Name:FUNCHION, JESSICA CLAIRE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CLAIRE
Last Name:FUNCHION
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:CLAIRE
Other - Last Name:FRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:150 MONUMENT RD
Mailing Address - Street 2:STE 207
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1702
Mailing Address - Country:US
Mailing Address - Phone:800-203-8657
Mailing Address - Fax:800-258-1426
Practice Address - Street 1:150 MONUMENT RD
Practice Address - Street 2:STE 207
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1702
Practice Address - Country:US
Practice Address - Phone:800-203-8657
Practice Address - Fax:800-258-1426
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86053365133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered