Provider Demographics
NPI:1215320031
Name:LYMAN, JENNIFER (RDN, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LYMAN
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 1:72 FREYMUTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1906
Mailing Address - Country:US
Mailing Address - Phone:314-322-8407
Mailing Address - Fax:314-344-6592
Practice Address - Street 1:18 W INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1926
Practice Address - Country:US
Practice Address - Phone:314-626-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014030811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered