Active NPI
Rachelle Lacroix Mallik, MA, RD, LDN
- Registered Dietitian
- Chicago, IL
National Provider Identifier
1649669920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164006383
- Practice address
- 4646 N Marine Dr
Chicago, IL 60640-5759 - Phone
- (773) 564-5920
- NPI assigned
- Jan 9, 2015
- 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 | 164006383 | IL | Primary |
Addresses
Primary practice location
4646 N Marine Dr
Chicago, IL 60640-5759
Mailing address
330 W Grand Ave
#1107
Chicago, IL 60654-5264
Phone (415) 640-6148
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164006383 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Food Therapist, PLLC | Dietitian, Registered | Current | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420761600000",
"number": "1649669920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 W GRAND AVE",
"address_2": "#1107",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606545264",
"telephone_number": "415-640-6148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 N MARINE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405759",
"telephone_number": "773-564-5920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLIK",
"first_name": "RACHELLE",
"middle_name": "LACROIX",
"credential": "MA, RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-09",
"last_updated": "2015-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164006383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.