Active NPI
Katie Marie Lick, R.D., L.D.
- Registered Dietitian
- St Louis Park, MN
National Provider Identifier
1326221607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2650
- Practice address
- 3525 Monterey Dr
St Louis Park, MN 55416-5275 - Phone
- (952) 993-5161
- NPI assigned
- Dec 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2650 | MN | Primary |
Addresses
Primary practice location
3525 Monterey Dr
St Louis Park, MN 55416-5275
Mailing address
3525 Monterey Dr
St Louis Park, MN 55416-5275
Phone (952) 993-5161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294617600000",
"number": "1326221607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 MONTEREY DR",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554165275",
"telephone_number": "952-993-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 MONTEREY DR",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554165275",
"telephone_number": "952-993-5161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICK",
"first_name": "KATIE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "R.D., L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-10",
"last_updated": "2011-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.