Provider Demographics
NPI:1740153618
Name:ROBACK, LAURA LEE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:ROBACK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1501
Mailing Address - Country:US
Mailing Address - Phone:330-414-0740
Mailing Address - Fax:
Practice Address - Street 1:833 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1501
Practice Address - Country:US
Practice Address - Phone:330-414-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered