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NPI Code Detail

MEDICARE: MS. JACLYN ANNE FORBES R.D., L.D.

MEDICARE: MS. JACLYN ANNE FORBES R.D., L.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian8134OH

General Provider Information

NPI Number : 1114479540
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACLYN ANNE FORBES R.D., L.D.
Provider Business Mailing Address
First Line : 2200 KERWIN RD
Second Line : APT. 503
City : UNIVERSITY HEIGHTS
State : OH
Zip : 44118-3971
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-1078
Country : US
Telephone Number : 216-444-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2016
Last Update Date : 12/07/2017

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