Provider Demographics
NPI:1821072364
Name:CAMPBELL, JENNIFER BARTLEY (MAS, RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BARTLEY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MAS, RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1103 NE 162ND ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6348
Mailing Address - Country:US
Mailing Address - Phone:530-902-7551
Mailing Address - Fax:
Practice Address - Street 1:21827 76TH AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7981
Practice Address - Country:US
Practice Address - Phone:425-776-7333
Practice Address - Fax:425-776-8373
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered