Provider Demographics
NPI:1649803578
Name:CROUCHER, JERI (RDN)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:CROUCHER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29398 RECOVERY WAY
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8447
Mailing Address - Country:US
Mailing Address - Phone:541-465-3049
Mailing Address - Fax:
Practice Address - Street 1:29398 RECOVERY WAY
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-8447
Practice Address - Country:US
Practice Address - Phone:541-465-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10172353133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered