Provider Demographics
NPI:1881647907
Name:EHLERT, JENNIFER (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:EHLERT
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:COVENANT CENTRAL BUSINESS OFFICE - MICHIGAN CAMPUS
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2963
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:SUITE 3101
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-583-5186
Practice Address - Fax:989-583-5226
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N55440004Medicare ID - Type Unspecified