Provider Demographics
NPI:1336680297
Name:LACH, KRISTEN (MS, RD, LDN, CNSC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LACH
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W VAN BUREN ST
Mailing Address - Street 2:SUITE 425 TOB
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5500
Mailing Address - Country:US
Mailing Address - Phone:312-942-5926
Mailing Address - Fax:
Practice Address - Street 1:1700 W VAN BUREN ST
Practice Address - Street 2:SUITE 425 TOB
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-5500
Practice Address - Country:US
Practice Address - Phone:312-942-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-12
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered