Active NPI
Kristin Lee Delleman, RD, LDN
- Registered Dietitian
- Hazel Crest, IL
National Provider Identifier
1740412162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.004660
- Practice address
- 17800 Kedzie Ave
Diabetes Wellness Program
Hazel Crest, IL 60429-2029 - Phone
- (708) 213-3286
- Fax
- (708) 213-0196
- NPI assigned
- Aug 18, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.004660 | IL | Primary |
Addresses
Primary practice location
17800 Kedzie Ave
Diabetes Wellness Program
Hazel Crest, IL 60429-2029
Mailing address
17800 Kedzie Ave
Diabetes Wellness Program
Hazel Crest, IL 60429-2029
Phone (708) 213-3286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.004660 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250553600000",
"number": "1740412162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17800 KEDZIE AVE",
"address_2": "DIABETES WELLNESS PROGRAM",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292029",
"telephone_number": "708-213-3286",
"fax_number": "708-213-0196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17800 KEDZIE AVE",
"address_2": "DIABETES WELLNESS PROGRAM",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292029",
"telephone_number": "708-213-3286",
"fax_number": "708-213-0196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLEMAN",
"first_name": "KRISTIN",
"middle_name": "LEE",
"name_prefix": "Miss",
"credential": "RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-18",
"last_updated": "2009-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.004660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.