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Individual

TONYA HAGENBAUMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.R.D.L.D.

Contact information

Practice address
2025 S. CHICAGO STREET, JOLIET, IL 60436
(815) 726-2200
Mailing address
2025 S CHICAGO ST, JOLIET, IL 60436-3172
(815) 726-2200

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
806637
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
164002717
STATE LICSENCE
IL
Enumeration date
10/07/2008
Last updated
10/07/2008
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