Provider Demographics
NPI:1396362430
Name:PREISS, CHELSEA (CNS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PREISS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2941
Mailing Address - Country:US
Mailing Address - Phone:206-719-6461
Mailing Address - Fax:
Practice Address - Street 1:1812 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2941
Practice Address - Country:US
Practice Address - Phone:206-719-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17959133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist