Provider Demographics
NPI:1912614140
Name:CLARK, JENNIFER ALICIA-BECKER (MS, RDN, CSOWM)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALICIA-BECKER
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, RDN, CSOWM
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Mailing Address - Street 1:3091 CRABTREE DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-7764
Mailing Address - Country:US
Mailing Address - Phone:517-605-8311
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:517-764-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management