Basic Information
Provider Information | |||||||||
NPI: | 1871099390 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OTT-SLENKER | ||||||||
FirstName: | JOANN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RD, LDN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 555 N. DUKE STREET | ||||||||
Address2: | ATTN: FOOD & NUTRITION SERVICES DEPT | ||||||||
City: | LANCASTER | ||||||||
State: | PA | ||||||||
PostalCode: | 176043555 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175447791 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 555 N. DUKE STREET | ||||||||
Address2: | ATTN: FOOD & NUTRITION SERVICES DEPT | ||||||||
City: | LANCASTER | ||||||||
State: | PA | ||||||||
PostalCode: | 176043555 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175447791 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/03/2018 | ||||||||
LastUpdateDate: | 05/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | DN004719 | PA | N |   | Other Service Providers | Health Educator |   | 133V00000X | DN004719 | PA | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.