Active NPI
Lisa Carlson, RD, LDN
- Registered Dietitian
- Lockport, IL
National Provider Identifier
1992233902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164007042
- Practice address
- 16221 W 159TH St Ste 102
Lockport, IL 60441-7959 - Phone
- (847) 868-3435
- NPI assigned
- Jun 2, 2017
- 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 | 164007042 | IL | Primary |
Addresses
Primary practice location
16221 W 159TH St Ste 102
Lockport, IL 60441-7959
Mailing address
175 E Hawthorn Pkwy Ste 235
Vernon Hills, IL 60061-1454
Phone (847) 868-3435
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164007042 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgewood Clinical Services, P.C. | Past | Accepting new patients | |
| PHC of Buffalo Grove Clinical Psychology | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychologist
- Naperville, IL
- NPI 1295914646
-
- Psychologist
- Vernon Hills, IL
- NPI 1235430612
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496361600000",
"number": "1992233902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 E HAWTHORN PKWY STE 235",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611454",
"telephone_number": "847-868-3435",
"fax_number": "847-868-3435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16221 W 159TH ST STE 102",
"city": "LOCKPORT",
"state": "IL",
"postal_code": "604417959",
"telephone_number": "847-868-3435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "LISA",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-02",
"last_updated": "2017-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164007042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lockport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.