Provider Demographics
NPI:1417563750
Name:REICHEK, BROOKE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:REICHEK
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 LULA ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5224
Mailing Address - Country:US
Mailing Address - Phone:832-443-9949
Mailing Address - Fax:
Practice Address - Street 1:4406 LULA ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-5224
Practice Address - Country:US
Practice Address - Phone:832-443-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered