Provider Demographics
NPI:1093844938
Name:KEDZIERSKI, CYNTHIA DESIREE (NT, RD, LDN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DESIREE
Last Name:KEDZIERSKI
Suffix:
Gender:F
Credentials:NT, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16406 S WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7666
Mailing Address - Country:US
Mailing Address - Phone:815-919-0312
Mailing Address - Fax:815-271-7339
Practice Address - Street 1:16406 S WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7666
Practice Address - Country:US
Practice Address - Phone:815-919-0312
Practice Address - Fax:815-271-7339
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist