Healthcare Provider Details

I. General information

NPI: 1811953672
Provider Name (Legal Business Name): LAURA J PLESKUNAS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LAURA J BENCK

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MADISON ST
JOLIET IL
60435-8200
US

IV. Provider business mailing address

15311 STRADFORD LN
ORLAND PARK IL
60462-6730
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax:
Mailing address:
  • Phone: 708-349-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: