Provider Demographics
NPI:1932489630
Name:FELDE, BETSY (RD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:FELDE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10350 HALIGUS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9585
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-802-7231
Practice Address - Street 1:10350 HALIGUS RD STE 220
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-802-7231
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered