Provider Demographics
NPI:1265075824
Name:KASPAREK, ELIZABETH (MS, RD, CSSD, CD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KASPAREK
Suffix:
Gender:F
Credentials:MS, RD, CSSD, CD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:KUCKUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1012 S PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0749
Mailing Address - Country:US
Mailing Address - Phone:608-609-5921
Mailing Address - Fax:
Practice Address - Street 1:791 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3844
Practice Address - Country:US
Practice Address - Phone:262-569-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered