Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jaci Elizabeth Lake, RD

Individual provider Registered Dietitian · NPI 1235776816

Jaci Elizabeth Lake, RD is a Registered Dietitian in Centralia, Illinois. Works from 2 locations. Licensed in Illinois.

Licensed in
IL
In the registry since
2019
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.

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Practice location Address checks out

432 N Pleasant Ave
Centralia, IL 62801-3006
Phone: (618) 436-8114
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5 Good Samaritan Way, Mount Vernon, IL 62864-2402 — (618) 436-8114

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 164.006872 (IL)

Record details

NPI number1235776816
Entity typeIndividual (Type 1)
GenderFemale
Credentials RD
Sole proprietorNo
NPI enumeratedDecember 3, 2019
Last updated in NPPESDecember 3, 2019

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