Provider Demographics
NPI:1063808756
Name:CHADBOURNE, JENNIFER (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHADBOURNE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RYE ST
Mailing Address - Street 2:STE 305
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6846
Mailing Address - Country:US
Mailing Address - Phone:888-320-1776
Mailing Address - Fax:617-507-8576
Practice Address - Street 1:15 RYE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6829
Practice Address - Country:US
Practice Address - Phone:888-320-1776
Practice Address - Fax:617-371-2950
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0734133V00000X
MA3686133V00000X
RILDN00843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered