Provider Demographics
NPI:1558661066
Name:BLOCKLINGER CAMPOS, DAWN (RD, LDN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BLOCKLINGER CAMPOS
Suffix:
Gender:
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 1:1403 N VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2201
Mailing Address - Country:US
Mailing Address - Phone:309-663-3050
Mailing Address - Fax:833-719-1241
Practice Address - Street 1:1403 N VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2201
Practice Address - Country:US
Practice Address - Phone:309-663-3050
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001733133V00000X
IA001848133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered