Provider Demographics
NPI:1164696159
Name:KLEPACKI, JEAN LOUISE (RD, LDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOUISE
Last Name:KLEPACKI
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 604
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035
Mailing Address - Country:US
Mailing Address - Phone:413-586-7740
Mailing Address - Fax:413-586-0766
Practice Address - Street 1:247 NORTHAMPTON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1051
Practice Address - Country:US
Practice Address - Phone:413-527-7676
Practice Address - Fax:413-527-2144
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2091-0221133V00000X
MA1206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000540502Medicare UPIN