Provider Demographics
NPI:1225373608
Name:REECE, JILLIAN E (RD LDN CSOWM)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:E
Last Name:REECE
Suffix:
Gender:F
Credentials:RD LDN CSOWM
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:E
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 900
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-2244
Mailing Address - Fax:617-636-2386
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 900
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-0158
Practice Address - Fax:617-636-2386
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered