Leslie Jackson-Vallade, LDN
Nutritionist in Upper Marlboro, MD. Individual provider (NPI-1).
NPI number1457051898
StatusActive
Last updated in NPPESMay 20, 2024
Details
- NPI
- 1457051898
- Entity type
- Individual (NPI-1)
- Name
- Leslie Jackson-Vallade
- Credential
- LDN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 6, 2023
- Certification date
- May 20, 2024
- Last updated
- May 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133N00000X | Nutritionist | DX5990 | MD | Yes |
| 171400000X | Health & Wellness Coach | – | – |
Practice location
3851 Pentland Hills DrUpper Marlboro, MD 20774-9242
Phone 443-519-9388
Mailing address
3851 Pentland Hills DrUpper Marlboro, MD 20774-9242
Phone 443-519-9388
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