Provider Demographics
NPI:1881482065
Name:KACALEK, LINDSAY ROXANNE (NTP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ROXANNE
Last Name:KACALEK
Suffix:
Gender:
Credentials:NTP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ROXANNE
Other - Last Name:BURDETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NTP
Mailing Address - Street 1:106 NW GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2914
Mailing Address - Country:US
Mailing Address - Phone:541-633-0623
Mailing Address - Fax:
Practice Address - Street 1:106 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2914
Practice Address - Country:US
Practice Address - Phone:541-633-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2423133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist