Provider Demographics
NPI:1417226325
Name:JORDAN, JAIMEE (MS, RDN, CDCES, CD)
Entity type:Individual
Prefix:MRS
First Name:JAIMEE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:
Credentials:MS, RDN, CDCES, CD
Other - Prefix:MS
Other - First Name:JAIMEE
Other - Middle Name:
Other - Last Name:WALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:1 PERSNICKETY PL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-3544
Mailing Address - Country:US
Mailing Address - Phone:920-892-3468
Mailing Address - Fax:
Practice Address - Street 1:1 PERSNICKETY PL
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-3544
Practice Address - Country:US
Practice Address - Phone:920-892-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1046746133V00000X
WI2415-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered