Provider Demographics
NPI:1508406232
Name:MENGE, LINDSEY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MENGE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 WHISPERING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5935
Mailing Address - Country:US
Mailing Address - Phone:512-565-0671
Mailing Address - Fax:
Practice Address - Street 1:4130 SPICEWOOD SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8657
Practice Address - Country:US
Practice Address - Phone:512-565-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86112133NN1002X, 133VN1301X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology