JACI ELIZABETH LAKE (NPI# 1235776816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235776816 |
| Entity Type | Individual |
| Full Name | JACI ELIZABETH LAKE |
| Credential | RD |
| Practice Address |
432 N Pleasant Ave Centralia IL 62801-3006 |
| Mailing Address |
7843 Coolidge Rd Oakdale IL 62268-1415 |
| Practice Telephone | 6184368114 |
| Mailing Telephone | 6189783551 |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2019-12-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 164.006872 | IL | Dietary & Nutritional Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5 Good Samaritan Way, Mount Vernon, IL 628642402 | 6184368114 |
| Street Address |
432 N PLEASANT AVE |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972615920 | Jeremy S Bowen | Physician Assistant | 432 N Pleasant Ave, Centralia, IL 62801-3006 | 2006-08-31 |
| 1326685983 | Chelsea M Price | Dietitian, Registered | 432 N Pleasant Ave, Centralia, IL 62801-3006 | 2019-12-03 |
| 1396288106 | Physician Services and Consulting, LLC | Surgery | 432 N Pleasant Ave, Centralia, IL 62801-3006 | 2016-11-28 |
| 1386815959 | Stacy D Menees | Nurse Practitioner | 432 N Pleasant Ave, Centralia, IL 62801-3006 | 2008-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720691561 | Paige Wetherbee | Dietitian, Registered | 917 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-08-30 |
| 1326685983 | Chelsea M Price | Dietitian, Registered | 432 N Pleasant Ave, Centralia, IL 62801-3006 | 2019-12-03 |
| 1700270295 | Heather Anne Powell | Dietitian, Registered | 1911 Cooks Hill Rd, Centralia, WA 98531-9073 | 2015-03-24 |
| 1649540345 | Lindsay Paige Bullock | Dietitian, Registered | 1911 Cooks Hill Rd, Centralia, WA 98531-9073 | 2012-01-11 |
| 1306148911 | Leanne K Burkhalter-eko | Dietitian, Registered | 230 Washington Way, Centralia, WA 98531-9325 | 2010-12-02 |
| 1467698910 | Sharon C Furrer | Dietitian, Registered | 1010 S Scheuber Rd, Pmg Sw Wa Dm Mnt Centralia, Centralia, WA 98531-8892 | 2009-01-05 |
| 1376629766 | Lynda Nguyen | Dietitian, Registered | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2006-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366726 | Frankie O'brien | Dietitian, Registered | 2551 N Clark St Ste 400, Chicago, IL 60614-7725 | 2020-11-04 |
| 1841891207 | Elizabeth Kristin Julius | Dietitian, Registered | 833 W Buena Ave Apt 1901, Chicago, IL 60613-6634 | 2020-11-03 |
| 1417556747 | Jamie Anne Mayhew | Dietitian, Registered | 2917 W 99th Pl, Evergreen Park, IL 60805-2641 | 2020-10-19 |
| 1033716345 | Efthemia Greco | Dietitian, Registered | 9654 Kelley Ln, Huntley, IL 60142-0058 | 2020-10-08 |
| 1679170203 | Lotus Therapy Group Inc | Dietitian, Registered | 112 Kansas St, Frankfort, IL 60423-1447 | 2020-10-06 |
| 1447857065 | Tran Huynh | Dietitian, Registered | 6126 N Rockwell St Apt 3, Chicago, IL 60659-2859 | 2020-10-06 |
| 1033716113 | Ulani Villanueva | Dietitian, Registered | 470 Pfingsten Road, Northbrook, IL 60062-2506 | 2020-10-02 |
| 1780281873 | Alyssa Marie Post | Dietitian, Registered | 3512 Rollingridge Rd, Naperville, IL 60564-8298 | 2020-10-02 |
| 1285231324 | Megan Rhodes | Dietitian, Registered | 539 Willowcreek Ct, Clarendon Hills, IL 60514-1693 | 2020-10-01 |
| 1508473711 | Susan Faith Madnek-oxman | Dietitian, Registered | 1051 Wade St, Highland Park, IL 60035-4153 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.