Provider Demographics
NPI:1649821125
Name:SCALA, JENNIFER KENNEDY (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KENNEDY
Last Name:SCALA
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TIDEWINDS TER
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1340
Mailing Address - Country:US
Mailing Address - Phone:781-990-1896
Mailing Address - Fax:
Practice Address - Street 1:16 TIDEWINDS TER
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1340
Practice Address - Country:US
Practice Address - Phone:781-990-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered