Provider Demographics
NPI:1609951052
Name:COOPER, CHERYL (RD, LD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5TH AVE. AND ROOSEVELT RD.
Mailing Address - Street 2:MAIL ROUTE 120
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE. AND ROOSEVELT RD.
Practice Address - Street 2:MAIL ROUTE 120
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered