Provider Demographics
NPI:1902632763
Name:WOLFF, JACQUELINE ANN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9484
Mailing Address - Country:US
Mailing Address - Phone:330-242-4020
Mailing Address - Fax:
Practice Address - Street 1:6525 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5461
Practice Address - Country:US
Practice Address - Phone:330-242-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered