Provider Demographics
NPI:1659033579
Name:ASHLEY LAKIN NUTRITION LLC
Entity Type:Organization
Organization Name:ASHLEY LAKIN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INTEGRATIVE NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:847-261-4693
Mailing Address - Street 1:525 GLENDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3233
Mailing Address - Country:US
Mailing Address - Phone:847-261-4693
Mailing Address - Fax:
Practice Address - Street 1:525 GLENDALE LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3233
Practice Address - Country:US
Practice Address - Phone:847-261-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty