Provider Demographics
NPI:1720707888
Name:ROKALA, JAMI SUE (RDN, CLC)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:SUE
Last Name:ROKALA
Suffix:
Gender:F
Credentials:RDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43000 COUNTY 3
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:MN
Mailing Address - Zip Code:56461-4139
Mailing Address - Country:US
Mailing Address - Phone:218-689-1907
Mailing Address - Fax:
Practice Address - Street 1:118 PAUL BUNYAN DR S
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3236
Practice Address - Country:US
Practice Address - Phone:218-689-1907
Practice Address - Fax:218-229-6054
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered