Provider Demographics
NPI:1154991438
Name:LEBLEU, GRACE (RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEBLEU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2804
Mailing Address - Country:US
Mailing Address - Phone:978-697-6828
Mailing Address - Fax:
Practice Address - Street 1:16 CONCORD RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-2804
Practice Address - Country:US
Practice Address - Phone:978-697-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered