Individual
MRS. ERIN M. KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.N.
Contact information
Practice address
3001 GREEN BAY ROAD, NORTH CHICAGO, IL 60064
(847) 636-3786
Mailing address
33 N. RIDGEMOOR AVE, MUNDELEIN, IL 60060
(847) 636-3786
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L91589
MEDICARE PART B
IL
Enumeration date
04/16/2008
Last updated
06/16/2011
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