Provider Demographics
NPI:1881220390
Name:BLEGEN, JENNA NOELLE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NOELLE
Last Name:BLEGEN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3208
Mailing Address - Country:US
Mailing Address - Phone:253-797-6209
Mailing Address - Fax:
Practice Address - Street 1:13311 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-3208
Practice Address - Country:US
Practice Address - Phone:253-797-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA86031809OtherCOMMISSION ON DIETETIC REGISTRATION