Healthcare Provider Details

I. General information

NPI: 1356857767
Provider Name (Legal Business Name): JENNIFER R ZUCCONI RD, LD, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 LOCH MAREE DR
PLANO TX
75093-4552
US

IV. Provider business mailing address

5908 LOCH MAREE DR
PLANO TX
75093-4552
US

V. Phone/Fax

Practice location:
  • Phone: 248-506-4008
  • Fax:
Mailing address:
  • Phone: 248-506-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number850079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: