Healthcare Provider Details

I. General information

NPI: 1336878495
Provider Name (Legal Business Name): JENNY LYNN ZOGLMAN RD, LD, MHCL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 LOOMIS ST
GARDEN PLAIN KS
67050-5003
US

IV. Provider business mailing address

641 LOOMIS ST
GARDEN PLAIN KS
67050-5003
US

V. Phone/Fax

Practice location:
  • Phone: 316-617-3518
  • Fax:
Mailing address:
  • Phone: 316-617-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1227
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1706
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: