Provider Demographics
NPI:1386292092
Name:DUNN, LACEY (MS, RD, LD, CPT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:MS, RD, LD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 NORFOLK ST APT 15109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3811
Mailing Address - Country:US
Mailing Address - Phone:770-841-0251
Mailing Address - Fax:
Practice Address - Street 1:3210 NORFOLK ST APT 15109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3811
Practice Address - Country:US
Practice Address - Phone:770-841-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered