Provider Demographics
NPI:1265057053
Name:LAGESON, JACQUELINE ELISE (MS, RD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELISE
Last Name:LAGESON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SMOKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4208
Mailing Address - Country:US
Mailing Address - Phone:925-336-1166
Mailing Address - Fax:
Practice Address - Street 1:8 SMOKEWOOD CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4208
Practice Address - Country:US
Practice Address - Phone:925-336-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered