Provider Demographics
NPI:1548371560
Name:HAAS, JENNIFER (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:STOKOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525-K EAST MARKET STREET
Mailing Address - Street 2:#117
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-380-4771
Mailing Address - Fax:
Practice Address - Street 1:20841 HOUSEMAN TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-4330
Practice Address - Country:US
Practice Address - Phone:703-380-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA93244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
011720N42Medicare PIN