Provider Demographics
NPI:1619312071
Name:SHIELD, JO ELLEN (RD)
Entity Type:Individual
Prefix:MRS
First Name:JO ELLEN
Middle Name:
Last Name:SHIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20428 N WEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8537
Mailing Address - Country:US
Mailing Address - Phone:312-305-6503
Mailing Address - Fax:
Practice Address - Street 1:20428 N WEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-8537
Practice Address - Country:US
Practice Address - Phone:312-305-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered