Provider Demographics
NPI:1053902874
Name:JOHNSON, REBEKAH ELISE (MS, RD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORTHCREST RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1227
Mailing Address - Country:US
Mailing Address - Phone:941-720-3440
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHCREST RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1227
Practice Address - Country:US
Practice Address - Phone:941-720-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered