Individual
JORDAN LESLIE BADGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
635 COMMONWEALTH AVE FL 6, BOSTON, MA 02215-1605
(617) 353-2721
Mailing address
635 COMMONWEALTH AVE FL 6, BOSTON, MA 02215-1605
(617) 353-2721
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4500
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4500
LICENSED DIETITIAN NUTRITIONIST
MA
01
—
86065640
REGISTERED DIETITIAN
—
Enumeration date
09/07/2018
Last updated
09/07/2018
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