Provider Demographics
NPI:1972835965
Name:MANIACI, JENNIFER R (RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MANIACI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W LOCKWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2327
Mailing Address - Country:US
Mailing Address - Phone:314-968-1900
Mailing Address - Fax:314-968-1901
Practice Address - Street 1:231 W LOCKWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2327
Practice Address - Country:US
Practice Address - Phone:314-968-1900
Practice Address - Fax:314-968-1901
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered