Provider Demographics
NPI:1104429554
Name:FLEMING, JENNIFER N (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:FLEMING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:LANGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10450 ALGONQUIN RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7064
Mailing Address - Country:US
Mailing Address - Phone:815-334-5566
Mailing Address - Fax:847-802-7259
Practice Address - Street 1:10450 ALGONQUIN RD STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7064
Practice Address - Country:US
Practice Address - Phone:815-334-5566
Practice Address - Fax:847-802-7259
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty