MEDICARE: MRS. JENNY LYNN ZOGLMAN RD, LD, MHCL

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
1	133V00000X	Registered Dietitian	1227	KS
2	133V00000X	Registered Dietitian	1706	OK

General Provider Information

NPI Number	:	1336878495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY LYNN ZOGLMAN RD, LD, MHCL

Provider Business Mailing Address
First Line	:	641 LOOMIS ST
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-5003
Country	:	US
Telephone Number	:	316-617-3518
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 LOOMIS ST
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-5003
Country	:	US
Telephone Number	:	316-617-3518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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