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General NPI Number Information
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NPI Number | 1275708505
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Entity Type | Individual
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Provider Name | JENNIFER LOUISE KOSLO MS, RD, CSSD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/25/2009
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Provider Practice Location Address
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Address Line | 5633 SOUTH 42ND STREET
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City | PHOENIX
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State | AZ
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Zip | 85040
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Country | US
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Telephone | 602-363-4442
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Fax |
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Provider Business Mailing Address
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Address Line | 1849 E GUADALUPE RD SUITE C101, PMB149
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City | TEMPE
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State | AZ
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Zip | 85283-3288
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Country | US
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Telephone | 602-363-4442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 863062
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 863062
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License Number State |
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