Provider Demographics
NPI:1295815900
Name:JARRETT, JACQUELINE (RD, LDN, CDE)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 MARCON BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-9371
Mailing Address - Country:US
Mailing Address - Phone:610-443-1885
Mailing Address - Fax:610-443-1685
Practice Address - Street 1:961 MARCON BLVD STE 115
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9371
Practice Address - Country:US
Practice Address - Phone:610-443-1885
Practice Address - Fax:610-443-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023924860001Medicaid
PA167629ZEYXMedicare PIN