Provider Demographics
NPI:1760121685
Name:HELGESON, KAILYN MARIE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:MARIE
Last Name:HELGESON
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8433
Mailing Address - Country:US
Mailing Address - Phone:608-386-8456
Mailing Address - Fax:
Practice Address - Street 1:444 S RAND RD STE 211
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2307
Practice Address - Country:US
Practice Address - Phone:224-475-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10549133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty