Provider Demographics
NPI:1942643614
Name:LEAHY, MAUREEN CALKINS (RD,LD)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:CALKINS
Last Name:LEAHY
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7144 N HARLEM AVE
Mailing Address - Street 2:SUITE 129
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1005
Mailing Address - Country:US
Mailing Address - Phone:708-860-3244
Mailing Address - Fax:773-774-3244
Practice Address - Street 1:7144 N HARLEM AVE
Practice Address - Street 2:SUITE 129
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1005
Practice Address - Country:US
Practice Address - Phone:708-860-3244
Practice Address - Fax:773-774-3244
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered