Provider Demographics
NPI:1013274042
Name:REILAND CUELLER, JENNIFER (RD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:REILAND CUELLER
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 1:20201 S. CRAWFORD AVE
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-679-2130
Mailing Address - Fax:708-679-2260
Practice Address - Street 1:20201 S. CRAWFORD AVE
Practice Address - Street 2:SUITE 1403
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-679-2130
Practice Address - Fax:708-679-2260
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5686016OtherMEDICARE PTAN