Provider Demographics
NPI:1225374432
Name:PHILLIPS, LAUREN (RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8197 SMITHS CIR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-3559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8197 SMITHS CIR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-3559
Practice Address - Country:US
Practice Address - Phone:419-651-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
164.005813133V00000X
TXDT90808133V00000X
OHLD.09716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT90808OtherLICENSE #
OHLD.09716OtherLICENSE #
IL164.005813OtherLICENSE #