Provider Demographics
NPI:1215781216
Name:REESE, KIM LASHAWN (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:LASHAWN
Last Name:REESE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 W MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8087
Mailing Address - Country:US
Mailing Address - Phone:210-920-1465
Mailing Address - Fax:
Practice Address - Street 1:5405 W MARGARET ST
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8087
Practice Address - Country:US
Practice Address - Phone:210-920-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.009739133NN1002X, 133VN1004X, 133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133N00000XDietary & Nutritional Service ProvidersNutritionist