Healthcare Provider Details

I. General information

NPI: 1013274042
Provider Name (Legal Business Name): JENNIFER REILAND CUELLER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 S. CRAWFORD AVE SUITE 1403
OLYMPIA FIELDS IL
60461
US

IV. Provider business mailing address

20201 S. CRAWFORD AVE SUITE 1403
OLYMPIA FIELDS IL
60461
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2130
  • Fax: 708-679-2260
Mailing address:
  • Phone: 708-679-2130
  • Fax: 708-679-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.004947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: