Katie Jo Leask, RD, LD, IBCLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D-655 Issued in ID

Practice address

2375 Coronado St
Idaho Falls, ID 83404-7407

Phone

(208) 522-4600

NPI assigned

Sep 24, 2019

Last updated

Sep 24, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1235780990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 KIMBERLY DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013821",
            "telephone_number": "208-521-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-522-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEASK",
        "first_name": "KATIE",
        "middle_name": "JO",
        "credential": "RD, LD, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "ID",
            "license": "L-62086",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "D-655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Macey Renae Leatham, RDN
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• Glenn Ralph Leavitt, DO
• Wade Darren Leavitt, LMSW
• Wende Christine Leavitt, PA-C

• Registered Dietitian in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.