Healthcare Provider Details

I. General information

NPI: 1669858882
Provider Name (Legal Business Name): LARISSA HABING R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LAURA LN
HIGHLAND IL
62249-1048
US

IV. Provider business mailing address

5 LAURA LN
HIGHLAND IL
62249-1048
US

V. Phone/Fax

Practice location:
  • Phone: 618-200-0230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.002934
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2005012528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: