Individual
KELLY BALCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN, CNSC
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 257-0879
Mailing address
11 CANDLEWOOD PL, WORCESTER, MA 01606-1204
(814) 404-1119
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
931366
MA
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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