Provider Demographics
NPI:1861022808
Name:HERRMANN, JESSICA FAYE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FAYE
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:FAYE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3416 N ASSOCIATION DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1479
Mailing Address - Country:US
Mailing Address - Phone:920-364-9078
Mailing Address - Fax:
Practice Address - Street 1:1710 LAWRENCE DR STE 200
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9195
Practice Address - Country:US
Practice Address - Phone:920-364-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered