Provider Demographics
NPI:1811366289
Name:YELCZYN, JENNIFER (RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YELCZYN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S. UNIVERSITY AVE
Mailing Address - Street 2:BEAVER DAM COMMUNITY HOSPITAL
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3089
Mailing Address - Country:US
Mailing Address - Phone:920-887-4333
Mailing Address - Fax:920-887-6802
Practice Address - Street 1:707 S. UNIVERSITY AVE.
Practice Address - Street 2:BEAVER DAM COMMUNITY HOSPITAL
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3027
Practice Address - Country:US
Practice Address - Phone:920-887-4333
Practice Address - Fax:920-887-6802
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1784-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered