Provider Demographics
NPI:1609612555
Name:LANGHOUGH, JORDAN (RD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:LANGHOUGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ELLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6907
Mailing Address - Country:US
Mailing Address - Phone:630-596-3333
Mailing Address - Fax:
Practice Address - Street 1:316 ELLWOOD LN
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6907
Practice Address - Country:US
Practice Address - Phone:630-596-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86172357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered