Provider Demographics
NPI:1740412162
Name:DELLEMAN, KRISTIN LEE (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:LEE
Last Name:DELLEMAN
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 1:17800 KEDZIE AVE
Mailing Address - Street 2:DIABETES WELLNESS PROGRAM
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2029
Mailing Address - Country:US
Mailing Address - Phone:708-213-3286
Mailing Address - Fax:708-213-0196
Practice Address - Street 1:17800 KEDZIE AVE
Practice Address - Street 2:DIABETES WELLNESS PROGRAM
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2029
Practice Address - Country:US
Practice Address - Phone:708-213-3286
Practice Address - Fax:708-213-0196
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered