Healthcare Provider Details

I. General information

NPI: 1437744562
Provider Name (Legal Business Name): JENNIFER SOMMER-DIRKS MS RD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 S CLARKSON ST
DENVER CO
80210-5803
US

IV. Provider business mailing address

2671 S CLARKSON ST
DENVER CO
80210-5803
US

V. Phone/Fax

Practice location:
  • Phone: 720-350-6199
  • Fax:
Mailing address:
  • Phone: 720-350-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: