Colleen Marie Kestel, MBA, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.007711 Issued in IL

Practice address

2081 Calistoga Dr Ste 2N
New Lenox, IL 60451-4833

Phone

(815) 320-2410

Fax

(815) 425-7123

NPI assigned

Apr 14, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Colleen O'Sullivan Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Locations

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.

• Systemic Wellness, P.C.

  • Adult Mental Health Clinic/Center
  • New Lenox, IL
  • NPI 1518697788
  NPD

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1881337129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14850 W DELANEY RD",
            "city": "MANHATTAN",
            "state": "IL",
            "postal_code": "604429660",
            "telephone_number": "708-609-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2081 CALISTOGA DR STE 2N",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604514833",
            "telephone_number": "815-320-2410",
            "fax_number": "815-425-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTEL",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "credential": "MBA, RDN, LDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-14",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.007711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mokena",
            "affiliation": "N",
            "endpointDescription": "Office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10062 W 190th Pl Ste 114",
            "city": "Mokena",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604488757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "O'SULLIVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mohammad Kamran Khan, D.O.
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• Jana Lindsey King, M.S., CCC/SLP

• Registered Dietitian in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.