=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013806942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY LEDUC MS, RD
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 RETREAT AVE
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-545-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64B SCHOOL ST
-----------------------------------------------------
City | COVENTRY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06238-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-636-8706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1004X
-----------------------------------------------------
Taxonomy Name | Pediatric Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 2706
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------