Provider Demographics
NPI:1922500719
Name:RICKETTS-BYRNE, JANINE (MA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:RICKETTS-BYRNE
Suffix:
Gender:F
Credentials:MA, RDN, LDN
Other - Prefix:MRS
Other - First Name:JANINE
Other - Middle Name:L
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:662 W KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6753
Mailing Address - Country:US
Mailing Address - Phone:847-302-2532
Mailing Address - Fax:
Practice Address - Street 1:1529 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5211
Practice Address - Country:US
Practice Address - Phone:847-302-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001459133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered