Provider Demographics
NPI:1992355416
Name:LEE, LAUREN M (RD, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BERESFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3140 DIEHL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-2726
Mailing Address - Country:US
Mailing Address - Phone:330-635-7692
Mailing Address - Fax:
Practice Address - Street 1:6200 PFEIFFER RD STE 360
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5861
Practice Address - Country:US
Practice Address - Phone:513-862-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08642133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered