Healthcare Provider Details

I. General information

NPI: 1982735403
Provider Name (Legal Business Name): BRENDA J. BAILLARGEON, RD, LDN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HASTINGS ST
MENDON MA
01756-1090
US

IV. Provider business mailing address

PO BOX 506
MENDON MA
01756-0506
US

V. Phone/Fax

Practice location:
  • Phone: 508-883-7322
  • Fax:
Mailing address:
  • Phone: 508-883-7322
  • Fax: 508-883-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number378
License Number StateMA

VIII. Authorized Official

Name: MRS. BRENDA J. BAILLARGEON
Title or Position: OWNER
Credential: RD, LDN
Phone: 508-883-7322