Individual
JESSICA JEAN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 441-7615
(508) 856-4287
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
86147917
NH
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
5190
MA
Other
Enumeration date
08/10/2020
Last updated
03/29/2021
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