MEDICARE: RHODE ISLAND NUTRITION THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LDN00792	RI

General Provider Information

NPI Number	:	1104365212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHODE ISLAND NUTRITION THERAPY, LLC

Provider Business Mailing Address
First Line	:	320 PHILLIPS ST STE 230
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5166
Country	:	US
Telephone Number	:	401-398-2454
Fax Number	:	401-633-6956

Provider Business Practice Location Address
First Line	:	320 PHILLIPS ST STE 230
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5166
Country	:	US
Telephone Number	:	401-398-2454
Fax Number	:	401-633-6956

Authorized Official
Title or Position	:	REGISTERED DIETITIAN NUTRITIONIST
Name	:	MS. WENDY HACKLEMAN LEONARD
Credential	:	RDN
Telephone Number	:	401-398-2454

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	12/10/2025

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