Provider Demographics
NPI:1942622360
Name:HONSELMAN, CARLA SUE (PHD, LDN, RD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:SUE
Last Name:HONSELMAN
Suffix:
Gender:F
Credentials:PHD, LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 1700TH RD
Mailing Address - Street 2:
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-3028
Mailing Address - Country:US
Mailing Address - Phone:217-254-0407
Mailing Address - Fax:
Practice Address - Street 1:11 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420-1612
Practice Address - Country:US
Practice Address - Phone:217-254-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered