Provider Demographics
NPI:1962212464
Name:SAVAGE, JACLYN (RD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:KONEFAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:425 CESSNA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6808
Mailing Address - Country:US
Mailing Address - Phone:704-840-7049
Mailing Address - Fax:
Practice Address - Street 1:425 CESSNA AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6808
Practice Address - Country:US
Practice Address - Phone:704-840-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2284133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered