Provider Demographics
NPI:1922205319
Name:TURNER-O'CONNELL, JUDITH A (RD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:TURNER-O'CONNELL
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 1:1646 W OLIVE AVE 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4103
Mailing Address - Country:US
Mailing Address - Phone:312-848-5083
Mailing Address - Fax:
Practice Address - Street 1:1646 W OLIVE AVE
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4103
Practice Address - Country:US
Practice Address - Phone:312-848-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005492133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered