Individual provider · NPI-1

Jackie L Comerford, RD

Dietitian, Registered · Mattoon, IL

NPI number1427132885
StatusActive
Last updated in NPPESApr 13, 2015

Details

NPI
1427132885
Entity type
Individual (NPI-1)
Name
Jackie L Comerford
Credential
RD
Sex
Female
Sole proprietor
No
Enumeration date
Oct 24, 2006
Last updated
Apr 13, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered164001482ILYes

Practice location

200 Lerna Rd S
Mattoon, IL 61938-9388

Phone 217-258-5900

Mailing address

611 W. Park St.
Bwpc
Urbana, IL 61801-2500

Phone 217-383-6792

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