Provider Demographics
NPI:1881337129
Name:KESTEL, COLLEEN MARIE (MBA, RDN, LDN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:KESTEL
Suffix:
Gender:F
Credentials:MBA, RDN, LDN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:O'SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14850 W DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-9660
Mailing Address - Country:US
Mailing Address - Phone:708-609-7227
Mailing Address - Fax:
Practice Address - Street 1:2081 CALISTOGA DR STE 2N
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4833
Practice Address - Country:US
Practice Address - Phone:815-320-2410
Practice Address - Fax:815-425-7123
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007711133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered