Provider Demographics
NPI:1144428988
Name:MATLIK, LEANN R (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:R
Last Name:MATLIK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:WUERTEMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8369 BLUESTEM LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4769
Mailing Address - Country:US
Mailing Address - Phone:317-838-9104
Mailing Address - Fax:
Practice Address - Street 1:1600 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1541
Practice Address - Country:US
Practice Address - Phone:317-782-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered