Healthcare Provider Details

I. General information

NPI: 1902384332
Provider Name (Legal Business Name): ALICIA KALINICH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 07/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W WINTHROP AVE
ELMHURST IL
60126-3316
US

IV. Provider business mailing address

257 W WINTHROP AVE
ELMHURST IL
60126-3316
US

V. Phone/Fax

Practice location:
  • Phone: 630-670-1655
  • Fax:
Mailing address:
  • Phone: 630-670-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164001591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: