Kelly Hameline Wicklander, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.005944 Issued in IL

Practice address

710 N Fairbanks CT Ste 7-121
Chicago, IL 60611-3013

Phone

(312) 926-7437

NPI assigned

Mar 14, 2014

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)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Dupage Physician Group

  • Family Medicine Physician
  • Carol Stream, IL
  • NPI 1033149844
  NPD (past)

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1811313828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N FAIRBANKS CT STE 7-121",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113013",
            "telephone_number": "312-926-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N FAIRBANKS CT STE 7-121",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113013",
            "telephone_number": "312-926-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLANDER",
        "first_name": "KELLY",
        "middle_name": "HAMELINE",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-14",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.005944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wicker Park Therapy Group, PLLC
• Gina Wickersheim
• Wickery Speech and Language Services
• Julie Wickery, M.A. CCC-SLP
• John B Wickham
• Maile Wicklander
• Jennifer C Wicklatz, APRN
• Nicole Wickliffe
• Catherine Ann Wicklund, MS, CGC
• Sarah Elizabeth Wicklund, CCC-SLP

• Registered Dietitian in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.