Provider Demographics
NPI:1063177384
Name:FORTE, JENNIFER (RDN, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FORTE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9141
Mailing Address - Country:US
Mailing Address - Phone:330-999-0058
Mailing Address - Fax:
Practice Address - Street 1:1239 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44216-9141
Practice Address - Country:US
Practice Address - Phone:330-999-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered