Provider Demographics
NPI:1518650993
Name:BALL, JORDAN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BUNKER HILL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1724
Mailing Address - Country:US
Mailing Address - Phone:774-262-7472
Mailing Address - Fax:
Practice Address - Street 1:380 BUNKER HILL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1724
Practice Address - Country:US
Practice Address - Phone:774-262-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6633133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered