Individual
JACKIE LENNETT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CDCES
Contact information
Practice address
213 ILENE DR, PLEASANT HILL, CA 94523-2226
(925) 819-0414
Mailing address
1888 BERKELEY WAY APT 306, BERKELEY, CA 94703-1684
(925) 819-0414
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86100784
CA
Other
Enumeration date
01/25/2019
Last updated
08/14/2023
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