Provider Demographics
NPI:1982899548
Name:WEIS, JENNIFER SUZANNE (RD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:WEIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S EUCLID
Mailing Address - Street 2:SUITE G
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108
Mailing Address - Country:US
Mailing Address - Phone:314-276-1789
Mailing Address - Fax:314-972-0472
Practice Address - Street 1:10 S EUCLID
Practice Address - Street 2:SUITE G
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-276-1789
Practice Address - Fax:314-972-0472
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7006038466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered