Provider Demographics
NPI:1538878087
Name:LAU, CHENELLE
Entity type:Individual
Prefix:
First Name:CHENELLE
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHENELLE
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RDN
Mailing Address - Street 1:3563 W 800 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7563
Mailing Address - Country:US
Mailing Address - Phone:801-414-0422
Mailing Address - Fax:
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-507-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1086721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered