Provider Demographics
NPI:1922666031
Name:CHAUSSE, JORDAN L (MS, RDN)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:L
Last Name:CHAUSSE
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 1:320 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5166
Mailing Address - Country:US
Mailing Address - Phone:413-329-7026
Mailing Address - Fax:
Practice Address - Street 1:320 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5166
Practice Address - Country:US
Practice Address - Phone:401-471-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN01105133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered