Provider Demographics
NPI:1619688546
Name:KEHOE, ZACHARY JAMES (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:KEHOE
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E HILLCREST DR APT 3104
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2449
Mailing Address - Country:US
Mailing Address - Phone:630-842-7347
Mailing Address - Fax:
Practice Address - Street 1:220 E HILLCREST DR APT 3104
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2449
Practice Address - Country:US
Practice Address - Phone:630-842-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered