MEDICARE: JESSICA PIECUCH RD,LD

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	LD.09210	OH

General Provider Information

NPI Number	:	1538022660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PIECUCH RD,LD

Provider Business Mailing Address
First Line	:	23700 COMMERCE PARK
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5827
Country	:	US
Telephone Number	:	216-292-5706
Fax Number	:

Provider Business Practice Location Address
First Line	:	6831 N CHESTNUT ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-297-4564
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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