Provider Demographics
NPI:1134724545
Name:SZCZEPANSKI, JESSICA ROSE (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROSE
Last Name:SZCZEPANSKI
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 W UNIVERSITY AVE APT 143
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3082
Mailing Address - Country:US
Mailing Address - Phone:507-450-6582
Mailing Address - Fax:
Practice Address - Street 1:923 W UNIVERSITY AVE APT 143
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3082
Practice Address - Country:US
Practice Address - Phone:507-450-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered