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

Theresa Renee Nickolaus, RD, LD, IBCLC

Individual provider Lactation Consultant (Non-RN) · NPI 1922774751

Theresa Renee Nickolaus, RD, LD, IBCLC is a Lactation Consultant (Non-RN) in Imperial, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2021
Specialties on file
2
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.
LD — Licensed Dietitian
A dietitian licensed by a state board.

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Practice location Address checks out

1011 Scenic Oaks Ct
Imperial, MO 63052-3457
Phone: (314) 363-6186
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Dietitian (primary) Taxonomy 133V00000X · Licence 2011041352 (MO)
Lactation Consultant (Non-RN) Taxonomy 174N00000X · Licence L-124884

Record details

NPI number1922774751
Entity typeIndividual (Type 1)
GenderFemale
Credentials RD , LD , IBCLC
Sole proprietorYes
NPI enumeratedAugust 20, 2021
Last updated in NPPESAugust 20, 2021
Certification dateAugust 20, 2021

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