MS. MINDY LEE WALLACE RD LDN NPI 1851305304

NPI Information

NPI: 1851305304
Provider Name: MS. MINDY LEE WALLACE, RD LDN
Classification: Dietitian, Registered - 133V00000X
Entity Type: Individual
Address: 935 JERSEY ST
QUINCY, IL
ZIP 62301
Phone: (217) 228-2413

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NPI Details

MS. Mindy Lee Wallace, RD LDN is a dietitian registered in Quincy, IL. The provider is a Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation. MS. Mindy Lee Wallace, RD LDN NPI is 1851305304. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

935 JERSEY ST
QUINCY, IL
ZIP 62301-030
Phone: (217) 228-2413
Fax: (217) 228-2416

The enumeration date for this NPI number is 7/28/2006 and was last updated on 9/22/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133V00000X	Dietitian, Registered		2005004105	MISSOURI	No
2	133V00000X	Dietitian, Registered		164003636	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	K26094	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS
2	075113	OTHER	ILLINOIS	QUINCY HEALTH CARE MANAGE
3	00132009	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD IL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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