Individual
JENNIFER WILFONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
400 GIBRALTAR LN, LORENA, TX 76655-3622
(719) 439-2470
Mailing address
400 GIBRALTAR LN, LORENA, TX 76655-3622
(719) 439-2470
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT83244
TX
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
DT83244
TX
Other
Enumeration date
07/16/2020
Last updated
03/08/2026
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