Provider Demographics
NPI:1962668392
Name:SMITH, JENNIFER LYNN (MS RD LD LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS RD LD LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 W DAVE LONGABERGER AVE
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:OH
Mailing Address - Zip Code:43821-9687
Mailing Address - Country:US
Mailing Address - Phone:740-252-8034
Mailing Address - Fax:614-722-3098
Practice Address - Street 1:59 W DAVE LONGABERGER AVE
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:OH
Practice Address - Zip Code:43821-9687
Practice Address - Country:US
Practice Address - Phone:740-252-8034
Practice Address - Fax:614-722-3098
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5531133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric