Provider Demographics
NPI:1699198077
Name:CORSIGLIA, KARA M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:CORSIGLIA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:150 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1463
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:150 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:815-942-2932
Practice Address - Fax:815-942-1873
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.006121OtherLDN