Provider Demographics
NPI:1699230466
Name:JALALI, LAUREN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JALALI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:KNIPPING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:333 LONGWOOD AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5711
Mailing Address - Country:US
Mailing Address - Phone:617-355-4677
Mailing Address - Fax:
Practice Address - Street 1:333 LONGWOOD AVE FL 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4667133V00000X
86145175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered