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JACI ELIZABETH LAKE RD
NPI 1235776816
Dietitian, Registered in Centralia, IL

Active since December 03, 2019
432 N PLEASANT AVE, CENTRALIA, IL 62801(618) 436-8114 Get Directions Write a Review

NPPES record last updated: December 3, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jaci Elizabeth Lake Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACI ELIZABETH LAKE RD (NPI 1235776816) is an individual dietitian, registered in Centralia, Illinois, licensed in Illinois (164.006872) and active in the NPI registry since December 2019. She maintains a secondary practice location in Mount Vernon.

NPPES Registry Identity

NPI1235776816
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameJACI ELIZABETH LAKECredential: RD
Location Address432 N PLEASANT AVECentralia, IL 62801-3006
Mailing Address7843 Coolidge RdOakdale, IL 62268-1415 · (618) 978-3551
Phone(618) 436-8114
Sole ProprietorNo
Enumeration DateDecember 3, 2019
✔ NPI 1235776816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in IL · 164.006872
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
432 N PLEASANT AVE, Centralia, IL 62801
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Secondary Practice Location 1

Location 15 Good Samaritan WayMount Vernon, IL 62864-2402 · Phone (618) 436-8114

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STACY D MENEES FNP
Nurse Practitioner (Family)
432 N PLEASANT AVE
CENTRALIA, IL 62801
Marion County (618) 436-8300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jaci Lake's NPI number?

The NPI number for Jaci Lake is 1235776816. It was assigned to this individual provider in the NPPES registry on December 3, 2019.

Where is Jaci Lake located?

Jaci Lake practices at 432 N Pleasant Ave, Centralia, IL 62801. The listed phone number is (618) 436-8114.

What is Jaci Lake's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

When was this NPI record last updated?

The NPPES record for Jaci Lake was last updated on December 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.