Individual
MS. JILL BAYOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Mailing address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
1072108
CO
136A00000X
Registered Dietetic Technician
21420304
CO
Other
Enumeration date
07/20/2015
Last updated
08/26/2015
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