Healthcare Provider Details

I. General information

NPI: 1992920441
Provider Name (Legal Business Name): RICHARD TODD DINEEN M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST FL 7
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1725 W HARRISON ST STE 1118
CHICAGO IL
60612-3845
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4500
  • Fax: 312-942-2380
Mailing address:
  • Phone: 312-563-4515
  • Fax: 312-942-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246000038
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: