Provider Demographics
NPI:1669790648
Name:LEGER - LEBLANC, GISELE (MS RD LDN CNSD)
Entity type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:LEGER - LEBLANC
Suffix:
Gender:F
Credentials:MS RD LDN CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ROCKY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1064
Mailing Address - Country:US
Mailing Address - Phone:508-686-3114
Mailing Address - Fax:508-686-3115
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-441-6280
Practice Address - Fax:774-443-3983
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered