Provider Demographics
NPI:1285763458
Name:LEBLANC, COLETTE MARIE (RD)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:MARIE
Last Name:LEBLANC
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 1:3401 W LOUISIANA STATE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2453
Mailing Address - Country:US
Mailing Address - Phone:504-228-6098
Mailing Address - Fax:985-651-5876
Practice Address - Street 1:502 RUE DE SANTE
Practice Address - Street 2:STE 306
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5424
Practice Address - Country:US
Practice Address - Phone:985-651-1557
Practice Address - Fax:985-651-5876
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered