Provider Demographics
NPI:1760447650
Name:CRANDALL, JESSICA L (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:7564 S XENIA CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2730
Mailing Address - Country:US
Mailing Address - Phone:303-562-4500
Mailing Address - Fax:833-875-6789
Practice Address - Street 1:7564 S XENIA CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2730
Practice Address - Country:US
Practice Address - Phone:303-562-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804975Medicare ID - Type Unspecified