Individual
MS. MARCY COQUILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, MS, NTP
Contact information
Practice address
24 S KASPAR AVE, ARLINGTON HEIGHTS, IL 60005-1631
(630) 220-3078
Mailing address
24 S KASPAR AVE, ARLINGTON HEIGHTS, IL 60005-1631
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
3119
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-1004610
NUTRITION PRACTIONER
IL
Enumeration date
10/22/2018
Last updated
10/22/2018
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