Individual
JACQLYN RAIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
1859 S TOPAZ WAY STE 100, MERIDIAN, ID 83642-4401
(208) 209-2432
(847) 859-5885
Mailing address
175 E HAWTHORN PKWY STE 235, VERNON HILLS, IL 60061-1454
(847) 737-8768
(847) 859-5885
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1101
ID
Other
Enumeration date
02/18/2019
Last updated
02/18/2019
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