Healthcare Provider Details

I. General information

NPI: 1255125068
Provider Name (Legal Business Name): HANNAH EMILY RAJLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 CHAMPIONS DR
COLUMBIA MO
65211-5509
US

IV. Provider business mailing address

239 CHAMPIONS DR
COLUMBIA MO
65211-5509
US

V. Phone/Fax

Practice location:
  • Phone: 217-621-4213
  • Fax:
Mailing address:
  • Phone: 217-621-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: