Provider Demographics
NPI:1053681940
Name:REYES, GISELLE MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:MARIE
Last Name:REYES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:GISELLE
Other - Middle Name:MARIE
Other - Last Name:WILLEFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:123 N WACKER DR STE 1250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1911
Mailing Address - Country:US
Mailing Address - Phone:612-876-7351
Mailing Address - Fax:
Practice Address - Street 1:123 N WACKER DR STE 1250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1911
Practice Address - Country:US
Practice Address - Phone:612-876-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered