Provider Demographics
NPI:1952744815
Name:BERGLUND, JESSICA MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WALNUT ST
Mailing Address - Street 2:1ST FLOOR- DIABETES MANAGEMENT SERVICES
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3504
Mailing Address - Country:US
Mailing Address - Phone:610-378-2031
Mailing Address - Fax:610-378-2543
Practice Address - Street 1:640 WALNUT ST
Practice Address - Street 2:1ST FLOOR- DIABETES MANAGEMENT SERVICES
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3504
Practice Address - Country:US
Practice Address - Phone:610-378-2031
Practice Address - Fax:610-378-2543
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004742133N00000X
PA1030122133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist