Provider Demographics
NPI:1700139284
Name:KOPFENSTEINER, MEGAN CHRISTINA (MS, RD, LDN, CNSC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:CHRISTINA
Last Name:KOPFENSTEINER
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CHRISTINA
Other - Last Name:DUBENETZKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7101 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1903
Mailing Address - Country:US
Mailing Address - Phone:317-709-3430
Mailing Address - Fax:
Practice Address - Street 1:7101 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1903
Practice Address - Country:US
Practice Address - Phone:317-709-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered