Provider Demographics
NPI:1194350124
Name:ALBERT, JENNA GORLICK (RDN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:GORLICK
Last Name:ALBERT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GORLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:6736 BARRETT RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2704
Mailing Address - Country:US
Mailing Address - Phone:954-336-7247
Mailing Address - Fax:
Practice Address - Street 1:4401 FAIRFAX DR STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1622
Practice Address - Country:US
Practice Address - Phone:571-328-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86118560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered