Provider Demographics
NPI:1215172028
Name:LEE, HANNAH KATE (RD LDN)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:KATE
Last Name:LEE
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1383
Mailing Address - Country:US
Mailing Address - Phone:309-830-6344
Mailing Address - Fax:
Practice Address - Street 1:212 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1383
Practice Address - Country:US
Practice Address - Phone:309-830-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered