Individual
JEANNINE ANNE GROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
130 E 3RD S, PRESTON, ID 83263-1530
(208) 852-2542
Mailing address
106 N BEAR RIVER BLFS, PRESTON, ID 83263-5184
(208) 406-9586
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
363888-4901
UT
133V00000X
Registered Dietitian
D-1334
ID
Other
Enumeration date
08/03/2021
Last updated
01/19/2026
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