Provider Demographics
NPI:1487132874
Name:MISCHLER, KAREN S (MS, RD, CLC, LDN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:MISCHLER
Suffix:
Gender:F
Credentials:MS, RD, CLC, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3169
Mailing Address - Country:US
Mailing Address - Phone:309-655-3453
Mailing Address - Fax:309-655-3410
Practice Address - Street 1:420 NE GLEN OAK AVE STE 301
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3169
Practice Address - Country:US
Practice Address - Phone:309-655-3453
Practice Address - Fax:309-655-3410
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003819133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered