Individual
KAYLA ELISE DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
231 W DAY RD, MISHAWAKA, IN 46545-1401
(574) 335-8445
Mailing address
707 CEDAR ST STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8707
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002825A
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37002825A
STATE OF INDIANA
IN
Enumeration date
02/09/2021
Last updated
02/09/2021
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