Healthcare Provider Details

I. General information

NPI: 1821072364
Provider Name (Legal Business Name): JENNIFER BARTLEY CAMPBELL MAS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MARIE BARTLEY RD

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21827 76TH AVE W SUITE 202
EDMONDS WA
98026-7981
US

IV. Provider business mailing address

1103 NE 162ND ST
SHORELINE WA
98155-6348
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-7333
  • Fax: 425-776-8373
Mailing address:
  • Phone: 530-902-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: