Provider Demographics
NPI:1568755999
Name:ALBERTSON, ELLEN R (ELLEN ALBERTSON)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:ALBERTSON
Suffix:
Gender:F
Credentials:ELLEN ALBERTSON
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:R
Other - Last Name:KAMENTSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:11 HARBOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7880
Mailing Address - Country:US
Mailing Address - Phone:802-497-0074
Mailing Address - Fax:802-497-0074
Practice Address - Street 1:11 HARBOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7880
Practice Address - Country:US
Practice Address - Phone:802-497-0074
Practice Address - Fax:802-497-0074
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740074380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered