Provider Demographics
NPI:1336015163
Name:EAKEN, ELESA D (MPH RD LD CLC)
Entity type:Individual
Prefix:
First Name:ELESA
Middle Name:D
Last Name:EAKEN
Suffix:
Gender:F
Credentials:MPH RD LD CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10376 WOOSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9514
Mailing Address - Country:US
Mailing Address - Phone:330-600-0811
Mailing Address - Fax:
Practice Address - Street 1:10376 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9514
Practice Address - Country:US
Practice Address - Phone:330-600-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty