Provider Demographics
NPI:1750124525
Name:ROBERTSON, JESSICA (RDN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:ROBERTSON
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 1:850 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8624
Mailing Address - Country:US
Mailing Address - Phone:541-737-9355
Mailing Address - Fax:
Practice Address - Street 1:850 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8624
Practice Address - Country:US
Practice Address - Phone:541-737-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered