Provider Demographics
NPI:1619318789
Name:SCHMIDT, KELLY O'CONNELL (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:O'CONNELL
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 N ASHLAND AVE # 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7788
Mailing Address - Country:US
Mailing Address - Phone:312-909-2809
Mailing Address - Fax:
Practice Address - Street 1:2530 N ASHLAND AVE # 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7788
Practice Address - Country:US
Practice Address - Phone:312-909-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.00584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered