Healthcare Provider Details

I. General information

NPI: 1144738048
Provider Name (Legal Business Name): JESSICA BADARACCO GRIFFEL RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNN BADARACCO

II. Dates (important events)

Enumeration Date: 01/14/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W KAGY BLVD STE A
BOZEMAN MT
59715-6045
US

IV. Provider business mailing address

115 W KAGY BLVD STE A
BOZEMAN MT
59715-6045
US

V. Phone/Fax

Practice location:
  • Phone: 406-282-1398
  • Fax:
Mailing address:
  • Phone: 406-282-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number66610
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: