Provider Demographics
NPI:1881938124
Name:CIUCCI, STEPHANIE (RD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:CIUCCI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 OGDEN AVE
Mailing Address - Street 2:104
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1691
Mailing Address - Country:US
Mailing Address - Phone:630-839-9296
Mailing Address - Fax:630-364-1873
Practice Address - Street 1:3080 OGDEN AVE
Practice Address - Street 2:104
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1691
Practice Address - Country:US
Practice Address - Phone:630-839-9296
Practice Address - Fax:630-364-1873
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered