Individual
JACQUELYN DIANE RALEIGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,LD,CDE
Contact information
Practice address
6500 N MOPAC, BLDG III, STE 220, AUSTIN, TX 78731
(512) 250-9140
(512) 250-2207
Mailing address
13729 RESEARCH BLVD, STE 610-193, AUSTIN, TX 78750-1883
(512) 250-9140
(512) 250-2207
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
DT80736
TX
133V00000X
Registered Dietitian
Primary
DT80736
TX
Other
Enumeration date
07/18/2008
Last updated
07/18/2008
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