Provider Demographics
NPI:1275788713
Name:ROCH, MELISSA ELLEN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ELLEN
Last Name:ROCH
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Gender:F
Credentials:RD, LD
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Mailing Address - Street 1:1255 W ADDISON ST
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3818
Mailing Address - Country:US
Mailing Address - Phone:773-360-7605
Mailing Address - Fax:773-360-7605
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:ADVOCATE ILLINOIS MASONIC MEDICAL CENTER, FOOD AND NUTR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-296-5912
Practice Address - Fax:773-296-5914
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL164.004658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered