Provider Demographics
NPI:1487983243
Name:LANGEVIN, LESLIE L (MS, RD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:LANGEVIN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MOUNTAIN VIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8081
Mailing Address - Country:US
Mailing Address - Phone:802-999-9207
Mailing Address - Fax:802-488-5704
Practice Address - Street 1:302 MOUNTAIN VIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8081
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:802-488-5704
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740061847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered