Provider Demographics
NPI:1427583590
Name:ADAMS, LORI (RDN, CSSD, CEDRD-S)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RDN, CSSD, CEDRD-S
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13100 MANCHESTER RD STE 175
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1729
Mailing Address - Country:US
Mailing Address - Phone:314-308-9115
Mailing Address - Fax:866-768-4036
Practice Address - Street 1:13100 MANCHESTER RD STE 175
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1729
Practice Address - Country:US
Practice Address - Phone:314-308-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO932549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered