Healthcare Provider Details

I. General information

NPI: 1922255165
Provider Name (Legal Business Name): JACQUELINE DAHLBERG M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 E NATIONAL RD
SPRINGFIELD OH
45505-1714
US

IV. Provider business mailing address

4230 E NATIONAL RD
SPRINGFIELD OH
45505-1714
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-8000
  • Fax: 937-323-6960
Mailing address:
  • Phone: 937-323-8000
  • Fax: 937-323-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD5723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: