Provider Demographics
NPI:1649818428
Name:HECKEL, JAYNE ELLEN ZOOK (RD, LD)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:ELLEN ZOOK
Last Name:HECKEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-0944
Mailing Address - Country:US
Mailing Address - Phone:541-350-5259
Mailing Address - Fax:
Practice Address - Street 1:19464 SE 362ND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9286
Practice Address - Country:US
Practice Address - Phone:541-350-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10203258133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered