Provider Demographics
NPI:1114591617
Name:GOEBEL, LEAH C (RDN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HURON ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2948
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-926-6285
Practice Address - Street 1:150 E HURON ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2948
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-926-6285
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered