Provider Demographics
NPI:1184744989
Name:THIES, EMMY M (BS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:EMMY
Middle Name:M
Last Name:THIES
Suffix:
Gender:F
Credentials:BS, RD, LDN
Other - Prefix:MISS
Other - First Name:EMMY
Other - Middle Name:M
Other - Last Name:SIDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RD, LDN
Mailing Address - Street 1:2421 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3034
Mailing Address - Country:US
Mailing Address - Phone:309-267-0595
Mailing Address - Fax:
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-353-0508
Practice Address - Fax:309-353-0710
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered