Active NPI
Jacqueline Ballou Erdos, MS, RD, CSSD, CDN
- Registered Dietitian
- Norwalk, CT
National Provider Identifier
1336382035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1753
- Practice address
- 40 Cross St
Norwalk, CT 06851-4647 - Phone
- (203) 229-2000
- Fax
- (203) 840-3153
- NPI assigned
- Apr 9, 2009
- Last updated
- Jun 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1753 | CT | Primary |
Addresses
Primary practice location
40 Cross St
Norwalk, CT 06851-4647
Mailing address
One Autumn Street Room 455
Childrens Hospital Boston,
Boston, MA 02115
Phone (617) 355-6097
Other names 1
- Jacqueline Renee Ballou
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1753 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560297600000",
"number": "1336382035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE AUTUMN STREET ROOM 455",
"address_2": "CHILDRENS HOSPITAL BOSTON,",
"city": "BOSTON",
"state": "MA",
"postal_code": "02115",
"telephone_number": "617-355-6097",
"fax_number": "617-730-0183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 CROSS ST",
"city": "NORWALK",
"state": "CT",
"postal_code": "068514647",
"telephone_number": "203-229-2000",
"fax_number": "203-840-3153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERDOS",
"first_name": "JACQUELINE",
"middle_name": "BALLOU",
"name_prefix": "Mrs.",
"credential": "MS, RD, CSSD, CDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-09",
"last_updated": "2019-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CT",
"license": "1753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "BALLOU",
"middle_name": "RENEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Norwalk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.