Provider Demographics
NPI:1134908734
Name:MORRISON, JESSICA LANG (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LANG
Last Name:MORRISON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EDWARDS HALL
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0001
Mailing Address - Country:US
Mailing Address - Phone:864-656-5514
Mailing Address - Fax:
Practice Address - Street 1:1181 HUTTO ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1467
Practice Address - Country:US
Practice Address - Phone:803-516-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered