Provider Demographics
NPI:1598322604
Name:DUCKETT, ZENA LEE (MA, RDN, LDN, CDCES)
Entity type:Individual
Prefix:MRS
First Name:ZENA
Middle Name:LEE
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:MA, RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BALA TER W
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1139
Mailing Address - Country:US
Mailing Address - Phone:610-470-5246
Mailing Address - Fax:
Practice Address - Street 1:TWO LOGAN SQUARE, 100 N 18TH STREET
Practice Address - Street 2:SUITE 324
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2733
Practice Address - Country:US
Practice Address - Phone:610-470-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered