Provider Demographics
NPI:1144612540
Name:SCHRECK, JESSICA ANN (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SCHRECK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 COATES AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2417
Mailing Address - Country:US
Mailing Address - Phone:631-484-4610
Mailing Address - Fax:
Practice Address - Street 1:1048 COATES AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2417
Practice Address - Country:US
Practice Address - Phone:631-484-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered