Provider Demographics
NPI:1619507902
Name:BARTOSIEWICZ, TAYLOR (RD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BARTOSIEWICZ
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 1:9050 MERION DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4788
Mailing Address - Country:US
Mailing Address - Phone:708-254-7996
Mailing Address - Fax:
Practice Address - Street 1:9050 MERION DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4788
Practice Address - Country:US
Practice Address - Phone:708-254-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86119146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered