Provider Demographics
NPI:1831273150
Name:DICK, LEA ANN S (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:LEA ANN
Middle Name:S
Last Name:DICK
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 MONTE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6327
Mailing Address - Country:US
Mailing Address - Phone:513-755-5245
Mailing Address - Fax:513-755-5250
Practice Address - Street 1:7593 TYLERS PLACE BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6312
Practice Address - Country:US
Practice Address - Phone:513-755-5240
Practice Address - Fax:513-755-5250
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL2414133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic