Provider Demographics
NPI:1184878860
Name:GUST, JESSICA LYNN (MS, RDN)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:GUST
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SCHOUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:405 EAST BRANCH STREET #102
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-550-1724
Mailing Address - Fax:805-476-1435
Practice Address - Street 1:405 EAST BRANCH STREET #102
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-550-1724
Practice Address - Fax:805-476-1435
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered