Terri Beatty, RDLDN

Individual provider Active NPI Registered Dietitian · Blue Island, IL

NPI 1952532004 · NPPES record last updated Aug 6, 2009

Key facts

NPI
1952532004
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
164.003527 (IL)
Practice address
12935 Gregory St
Blue Island, IL 60406-2428
Phone
(708) 597-2000
Fax
(708) 824-4654
NPI assigned
Aug 6, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
164.003527ILMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164.003527 IL Yes

Addresses

Primary practice location

12935 Gregory St
Blue Island, IL 60406-2428

Mailing address

12935 Gregory St
Blue Island, IL 60406-2428
Phone (708) 597-2000

Other providers in Blue Island, IL

All providers in Blue Island, IL · Registered Dietitian in Illinois

Sources for this page

Verify at the official NPI Registry.