Provider Demographics
NPI:1770112757
Name:YOST, JESSICA JACQUELINE (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JACQUELINE
Last Name:YOST
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 1:953 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4003
Mailing Address - Country:US
Mailing Address - Phone:330-475-5862
Mailing Address - Fax:
Practice Address - Street 1:953 MORRIS RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4003
Practice Address - Country:US
Practice Address - Phone:330-475-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered