Provider Demographics
NPI:1346921632
Name:LYONS, LACEY JO (RD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:JO
Last Name:LYONS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 BLUEGRASS LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-2075
Mailing Address - Country:US
Mailing Address - Phone:217-552-2851
Mailing Address - Fax:
Practice Address - Street 1:1506 BLUEGRASS LN
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-2075
Practice Address - Country:US
Practice Address - Phone:217-552-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered