Provider Demographics
NPI:1699917187
Name:BACHER, JACLYN JOANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:JOANNE
Last Name:BACHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:JOANNE
Other - Last Name:GINGRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:425 HOME ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1407
Mailing Address - Country:US
Mailing Address - Phone:937-378-7892
Mailing Address - Fax:937-378-7744
Practice Address - Street 1:425 HOME ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1407
Practice Address - Country:US
Practice Address - Phone:937-378-7892
Practice Address - Fax:937-378-7744
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6279133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered