Colleen Clesen, NDTR

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

License

86081341 Issued in IL

Practice address

14 N Island Ave
Batavia, IL 60510-1929

Phone

(630) 479-2086

NPI assigned

Apr 25, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1760238299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 ASH ST",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601744120",
            "telephone_number": "630-479-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 N ISLAND AVE",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605101929",
            "telephone_number": "630-479-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLESEN",
        "first_name": "COLLEEN",
        "credential": "NDTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "IL",
            "license": "86081341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietetic Technician in Batavia, IL
• Providers in Batavia, IL by specialty
• Registered Dietetic Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.