Provider Demographics
NPI:1457784829
Name:CHAMERLIK, JACQUELINE ERIN (MS, MT(ASCP))
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ERIN
Last Name:CHAMERLIK
Suffix:
Gender:F
Credentials:MS, MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 HEATHER GLEN CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2745
Mailing Address - Country:US
Mailing Address - Phone:224-788-3010
Mailing Address - Fax:
Practice Address - Street 1:950 HEATHER GLEN CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-2745
Practice Address - Country:US
Practice Address - Phone:224-788-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist