Provider Demographics
NPI:1790674950
Name:LAUGHLIN, AMY CHRISTINE (RD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2524
Mailing Address - Country:US
Mailing Address - Phone:314-972-2552
Mailing Address - Fax:
Practice Address - Street 1:1007 RICHARD DR
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2524
Practice Address - Country:US
Practice Address - Phone:314-972-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered