Provider Demographics
NPI:1851634679
Name:JACOBS, MALLORY JEAN (RD)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:JEAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4681 STEPHANIE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9219
Mailing Address - Country:US
Mailing Address - Phone:989-450-9118
Mailing Address - Fax:
Practice Address - Street 1:4681 STEPHANIE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9219
Practice Address - Country:US
Practice Address - Phone:989-450-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered