Provider Demographics
NPI:1124478672
Name:MCDOUGALL, JENNA (RDN, LD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:SCHUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2104 SARGENT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1125
Mailing Address - Country:US
Mailing Address - Phone:651-983-4391
Mailing Address - Fax:
Practice Address - Street 1:621 W LAKE ST STE 350
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2952
Practice Address - Country:US
Practice Address - Phone:651-983-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3709133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered