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NPI Code Detail

MEDICARE: MRS. JESSICA LEE MOUSSEAU MS, RDN

MEDICARE: MRS. JESSICA LEE MOUSSEAU MS, RDN
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
1133V00000XRegistered Dietitian86109504MA

General Provider Information

NPI Number : 1467083089
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA LEE MOUSSEAU MS, RDN
Provider Business Mailing Address
First Line : 11 BROOKFIELD RD
Second Line :
City : MILFORD
State : MA
Zip : 01757-1302
Country : US
Telephone Number : 774-573-9835
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 774-442-3230
Fax Number : 774-443-3983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2020
Last Update Date : 02/04/2026

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