Provider Demographics
NPI:1811497126
Name:KEAN, EMILY A (MBA, RDN, LDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:KEAN
Suffix:
Gender:F
Credentials:MBA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6923
Mailing Address - Country:US
Mailing Address - Phone:312-627-0444
Mailing Address - Fax:312-648-0155
Practice Address - Street 1:444 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6923
Practice Address - Country:US
Practice Address - Phone:312-627-0444
Practice Address - Fax:312-648-0155
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006672133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist