Provider Demographics
NPI:1649993916
Name:DOUCET, MARCELLA A (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:A
Last Name:DOUCET
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11630 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRIONETTE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6302
Mailing Address - Country:US
Mailing Address - Phone:708-438-8032
Mailing Address - Fax:708-389-9088
Practice Address - Street 1:11630 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6302
Practice Address - Country:US
Practice Address - Phone:708-438-8032
Practice Address - Fax:708-389-9088
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003501A133VN1005X
IL164.008601133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal