Provider Demographics
NPI:1205331998
Name:BLECHLE, LAUREN (RDN, LD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BLECHLE
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 1:3615 19TH ST BLDG 17
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1203
Mailing Address - Country:US
Mailing Address - Phone:806-725-0358
Mailing Address - Fax:806-725-4384
Practice Address - Street 1:3615 19TH ST BLDG 17
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-0358
Practice Address - Fax:806-725-4384
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered