Healthcare Provider Details

I. General information

NPI: 1417807827
Provider Name (Legal Business Name): JESSI LEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6561 RIDGEWOOD RD
CLARKSTON MI
48346-1024
US

IV. Provider business mailing address

6561 RIDGEWOOD RD
CLARKSTON MI
48346-1024
US

V. Phone/Fax

Practice location:
  • Phone: 248-326-8828
  • Fax:
Mailing address:
  • Phone: 248-326-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JESSICA LEE GOLDING
Title or Position: REGISTERED DIETITIAN
Credential: RDN
Phone: 248-326-8828