Provider Demographics
NPI:1952860413
Name:MEALICK, CHELSEA BROOKE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:BROOKE
Last Name:MEALICK
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 1:967 RIDGELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2639
Mailing Address - Country:US
Mailing Address - Phone:740-973-2853
Mailing Address - Fax:
Practice Address - Street 1:967 RIDGELAWN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2639
Practice Address - Country:US
Practice Address - Phone:740-973-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.8180133N00000X
86041911133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist