Provider Demographics
NPI:1053059543
Name:SCHNICKE, ELISABETH (RD, LD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:SCHNICKE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LIZZY
Other - Middle Name:
Other - Last Name:SCHNICKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:410 W 10TH AVE STE W180
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-8036
Mailing Address - Fax:
Practice Address - Street 1:410 W 10TH AVE STE W180
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered