Jaci Elizabeth Lake, RD is a
Dietitian, Registered based in Centralia, Illinois. Jaci Elizabeth Lake is licensed to practice in Illinois (license number 164.006872) and her current practice location is
432 N Pleasant Ave, Centralia, Illinois. She can be reached at her office (for appointments etc.) via phone at
(618) 436-8114.
NPI number for Jaci Elizabeth Lake is 1235776816 and her current mailing address is 7843 Coolidge Rd, Oakdale, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1235776816.
Healthcare Provider's Profile
Full Name | Jaci Elizabeth Lake |
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Gender | Female |
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Speciality | Dietitian, Registered |
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Location | 432 N Pleasant Ave, Centralia, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1235776816
- Provider Enumeration Date: 12/03/2019
- Last Update Date: 12/03/2019
Medical Identifiers
Medical identifiers for Jaci Elizabeth Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1235776816 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
133V00000X | Dietitian, Registered | 164.006872 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaci Elizabeth Lake is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jaci Elizabeth Lake, RD 7843 Coolidge Rd, Oakdale, IL 62268-1415 Ph: (618) 978-3551 | Jaci Elizabeth Lake, RD 432 N Pleasant Ave, Centralia, IL 62801-3006 Ph: (618) 436-8114 |
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