Provider Demographics
NPI:1861289183
Name:O'DWYER, JESSICA LEE (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:O'DWYER
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 1:14121 GRANT ST # 2-322
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6685
Mailing Address - Country:US
Mailing Address - Phone:720-670-6101
Mailing Address - Fax:
Practice Address - Street 1:14121 GRANT ST # 2-322
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80023-6685
Practice Address - Country:US
Practice Address - Phone:720-670-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered