Provider Demographics
NPI:1467083089
Name:PELLETIER, JESSICA LEE (MS, RDN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1302
Mailing Address - Country:US
Mailing Address - Phone:774-573-9835
Mailing Address - Fax:
Practice Address - Street 1:11 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1302
Practice Address - Country:US
Practice Address - Phone:774-573-9835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86109504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered