Healthcare Provider Details

I. General information

NPI: 1629446786
Provider Name (Legal Business Name): SUZANNE BERKLEY R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25021 W PRAIRIE GROVE DR
PLAINFIELD IL
60585-7883
US

IV. Provider business mailing address

25021 W PRAIRIE GROVE DR
PLAINFIELD IL
60585-7883
US

V. Phone/Fax

Practice location:
  • Phone: 847-507-3757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.003712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: