Provider Demographics
NPI:1184909541
Name:VAN ARSDALE, JACKLYN MARIE (RD, LDN, LPC)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MARIE
Last Name:VAN ARSDALE
Suffix:
Gender:F
Credentials:RD, LDN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176B MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8894
Mailing Address - Country:US
Mailing Address - Phone:267-402-0252
Mailing Address - Fax:
Practice Address - Street 1:101 W MAIN ST UNIT G2
Practice Address - Street 2:
Practice Address - City:SALUNGA
Practice Address - State:PA
Practice Address - Zip Code:17538-1109
Practice Address - Country:US
Practice Address - Phone:267-402-0252
Practice Address - Fax:717-618-8376
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004686133V00000X
PAPC012543101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional