Organization
DIETITIAN PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE RUSS LDN, CNS (OWNER)
(847) 769-3393
Entity
Organization
Contact information
Practice address
1000 ESSINGTON RD FL 1, JOLIET, IL 60435-2841
(847) 769-3393
Mailing address
34W038 COUNTRY CLUB RD, ST CHARLES, IL 60174-1471
(847) 769-3393
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
12/02/2025
Last updated
12/02/2025
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