Provider Demographics
NPI:1720564057
Name:ANDERSON, JENNA CATHERINE (RDN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:CATHERINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:CATHERINE
Other - Last Name:BAUTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3505
Mailing Address - Country:US
Mailing Address - Phone:320-632-5441
Mailing Address - Fax:
Practice Address - Street 1:815 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3505
Practice Address - Country:US
Practice Address - Phone:320-632-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4093133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered